Routine fecal occult blood testing does not predict necrotizing enterocolitis in very low birth weight neonates

Pickering, A.; White, Rachel; Davis, Natalie L.

doi:10.3233/npm-16915120

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…This is supported by other studies that found that there is limited association between occult haematochezia and necrotising enterocolitis, and thus limited utility of routine faecal occult blood testing in infants. [10][11][12] Although there is no correlation between heme-positive stools and increased incidence of gastrointestinal emergencies, there were no gastrointestinal emergencies in the patients with hemenegative stools in our study.…”

Section: Discussioncontrasting

confidence: 63%

“…9 In addition, studies have shown that the sensitivity, specificity, and positive predictive values of a positive faecal occult blood test among very low birth weight infants in the neonatal intensive-care unit were 0, 34.4, and 0%, respectively. 10 Due to the limited proven association between occult haematochezia and necrotising enterocolitis, some studies have found that routine faecal occult blood testing is not a useful diagnostic tool for neonatal patients. 11,12 As a result, some centres have discontinued routine testing.…”

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confidence: 99%

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The utility of guaiac stool testing in the detection of gastrointestinal complications in infants with critical congenital heart disease

et al. 2019

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Background:Guaiac stool testing has been routinely used as a method to detect gastrointestinal complications in infants with critical congenital heart disease (CHD); however, the sensitivity and specificity have not been established.Methods:A retrospective chart review was performed investigating the presence of heme-positive stools and subsequent gastrointestinal complications as well as time to goal caloric intake and radiograph exposure.Results:The presence of heme-positive stools was not a statistically significant factor in patients with critical CHD that experienced gastrointestinal complications. Additionally, patients with heme-positive stools did undergo more abdominal X-rays than those with heme-negative stools.Conclusions:The routine use of guaiac stool testing in infants with critical CHD is not a predictor of possible gastrointestinal complications and leads to more radiograph exposure for the patient. Close clinical monitoring can be used to evaluate feeding tolerance in infants with critical CHD.

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Section: Discussioncontrasting

confidence: 63%

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confidence: 99%

The utility of guaiac stool testing in the detection of gastrointestinal complications in infants with critical congenital heart disease

et al. 2019

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“…Numerous screening strategies have been attempted including routine fecal occult blood (FOB) testing and RGA monitoring. While routine FOB testing has been largely debunked and is falling out of favor (13,14), RGA persists despite limited supportive evidence. Early studies of RGA monitoring seemed to indicate that more frequent and larger gastric aspirate volumes could be predictive of NEC (3,4).…”

Section: Discussionmentioning

confidence: 99%

Impact of Routine Gastric Aspirate Monitoring on Very Low Birth Weight Early Preterm Infants

Mangalapally

Patel

Schofield

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Routine gastric aspirate (RGA) monitoring is a common yet controversial practice intended for early identification of gastrointestinal pathology in infants receiving gavage feeds. Our objectives were to evaluate the association of ceasing RGA monitoring on the incidence of necrotizing enterocolitis (NEC) as well as nutritional outcomes in a large population of very low birth weight (VLBW) and very preterm neonates. Methods: Retrospective record review of neonates born ≤32 weeks and/or VLBW from 2 cohorts: (1) during pre-feed RGA monitoring (September 2015 to June 2018) and ( 2) after cessation of RGA ("non-RGA") monitoring (July 2018 to December 2020). We compared incidence of NEC, time-tofull enteral feeds, central line duration, and duration of parenteral nutrition (PN) in bivariate and multivariable models accounting for changes in feeding protocols over time. Results: We identified 617 subjects, 53% in the RGA monitoring cohort (n = 327) and 47% in non-RGA cohort (n = 290). The non-RGA cohort had feeds initiated earlier (P < 0.0001), achieved full enteral feeds more rapidly (P < 0.0001), received a shorter duration of PN (P = 0.0003), and had shorter central access duration (P < 0.0001) without increasing NEC risk. In fact, the non-RGA cohort had a lower incidence of NEC (P = 0.0345) compared to the RGA cohort. Even after adjusting for changes in feeding protocols over time in a multivariable model, the RGA cohort had significantly higher odds of NEC. Conclusions: Pre-feed RGA monitoring in the absence of concerning clinical exam findings is not indicated for neonates receiving gavage feeds as it does not improve NEC incidence but instead may delay important nutritional outcomes such as feed initiation and central line removal.

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“…Pickering A et al . 20 have reported that routine fecal occult blood testing does not predict necrotizing enterocolitis. Therefore, although we could not provide an early warning of severe disease though FOBT, and the early intervention for FOBT might not decrease NEC, sFA, structural bowel injuries, or any other complications, the significance of newborn FOBT positivity lies in that, medical staff would be alert to the related diseases including NEC, gastrointestinal malformations and suspected food allergy, with closer observation and follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of positive fecal occult blood test in neonates

Wen

Wang

Yue

et al. 2019

Sci Rep

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The fecal occult blood test (FOBT) is a screening tool for hematochezia. This study aims to summarize the clinical features associated with a positive FOBT in neonates and to explore some clues for the underlying causes. Combination with other clinical information, identifying the possible etiology is more likely and could be useful for choosing an effective therapeutic strategy. The medical records of 282 neonates with positive FOBTs from January 1 to July 31, 2016, were collected and retrospectively analyzed. The total incidence rate of FOBT positivity in neonates was 6.2%. Among these patients, 71 (25.2%) neonates had false-positive FOBTs, whereas 211 (74.8%) neonates had intraintestinal sources of hematochezia. Necrotizing enterocolitis (NEC, 20.9%), structural abnormalities of gastrointestinal tract (SAGT, 12.4%), and suspected food allergy (sFA, 10.6%) were the most common causes of neonatal hematochezia. It indicated that FOBT-positive neonates with NEC were more likely to suffer due to a younger gestational age, lower birth weight, and lower weight on admission than the neonates with other conditions. The proportions of neonates with bloody stool (90.0%) and diarrhea (63.3%) in the sFA group were markedly higher than those in the other groups. However, in the SAGT group, emesis (94.3%) and abdominal distension (80.0%) were evidently higher, usually accompanied by a relatively poor response (60.0%) and weakened bowel sounds (48.6%). Furthermore, the higher incidences of poor response (72.1%), abdominal distension (71.2%), bloody stools (64.4%), and weakened bowel sounds (62.7%) were observed in the NEC group. Due to the complicated etiology associated with a positive FOBT, the analyzed indexes were combined with other clinical features to identify the likely causes of neonatal hematochezia. Because NEC, sFA and SAGT show similar clinical manifestations and can occasionally transform into each other, close and frequent observation is crucial for timely intervention to achieve a better prognosis. Although it failed to provide an early warning of severe disease through FOBT, and the early intervention for FOBT might not decrease NEC, sFA, structural bowel injuries, or any other complications, newborn FOBT positive reminds medical staff to be alert to the related diseases including NEC, SAGT and sFA, by closer observation and follow-up.

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Routine fecal occult blood testing does not predict necrotizing enterocolitis in very low birth weight neonates

Cited by 7 publications

References 13 publications

The utility of guaiac stool testing in the detection of gastrointestinal complications in infants with critical congenital heart disease

The utility of guaiac stool testing in the detection of gastrointestinal complications in infants with critical congenital heart disease

Impact of Routine Gastric Aspirate Monitoring on Very Low Birth Weight Early Preterm Infants

Clinical significance of positive fecal occult blood test in neonates

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