Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes

Bethell, George; Knight, Marian; Hall, Nigel

doi:10.1016/j.jpedsurg.2021.04.028

Cited by 27 publications

(24 citation statements)

References 25 publications

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“…Gestational age as an important maternal factor has been recognized in previous studies to be an independent risk factor for both NEC and surgical needs for NEC (15)(16)(17). A previous study investigating the association between gestational age and surgical timing and outcomes for NEC observed that an increase in gestation at birth per week might shorten an average of 0.45 h from a suspicion of NEC to first surgical intervention (18). They also found that a lower gestational age is an independent risk factor for increased 28-day mortality or parenteral nutrition requirement (adjusted OR: 0.85, 95% CI, 0.77-0.94, p = 0.001).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

Liu

et al. 2022

Front. Surg.

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BackgroundThe current indications based on the clinicopathological parameters for predicting the need for surgery in neonatal necrotizing enterocolitis (NEC) are still limited. This study retrospectively analyzes the characteristics of neonatal NEC and aims to identify the risk factors for surgical intervention in NEC.MethodsData of the NEC cases from 2015 to 2019 were collected from our institution and divided into two groups: surgical group (n = 41) and conservative treatment group (n = 143). Clinical, physical, and laboratory measures were analyzed by univariate analysis and multivariate logistic regression. The diagnostic values and receiver operative characteristic (ROC) curve were used for the assessment.ResultsUnivariate analysis identified significant differences between the surgical group and the conservative group in a series of clinical, physical, and laboratory measures (all p < 0.05). The results of multivariate logistic regression analysis showed that procalcitonin (adjusted OR: 167.1, 95% CI, 3.585–7,788.758, p = 0.009) and gestational age (adjusted OR: 0.85, 95% CI, 0.77–0.94, p = 0.001) were independent surgical indications for NEC. The results from ROC curve and diagnosis values demonstrated that procalcitonin [the area under the curve (AUC) = 0.864], CRP (AUC = 0.783) and fibrinogen (AUC = 0.720) had good predictive performance for surgical NEC.ConclusionsThe level of procalcitonin and gestational age were found to be independent surgical indications for neonates with NEC.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

Liu

et al. 2022

Front. Surg.

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“…Recent researches reported that more than 30% of neonates with NEC may require surgical intervention, and mortality rate among surgical NEC cases is estimated to be 20% ~ 30% [ 3 , 21 ]. But in this cohort, we found that overall proportion of surgical intervention was 40.4% (33.3% cases received surgery for primary NEC and 7.1% for later complications), the rate of surgical intervention was higher than most reports.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we also collected data on red blood cell transfusions within 48 h before NEC diagnosis. The prognosis of interest was NEC-related death during hospitalization or within the 3-month follow-up period after discharge [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Univariable analysis was utilized to screen out the following 10 variables: WBC, HB, PLT, CRP, PCT, PT, PT-INR, APTT, Fib and DD, potentially affecting surgical NEC. Logistic regression was used to explore associations between potential independent variables and dependent variables taking into account clinically important and meaningful confounders [ 21 ]. Subsequently, receiver operating characteristics (ROC) analysis was obtained to identify the optimal cut-off values for coagulation parameters with sensitivity/specificity and to calculate the area under the ROC curves (AUC), respectively.…”

Section: Methodsmentioning

confidence: 99%

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Application of coagulation parameters at the time of necrotizing enterocolitis diagnosis in surgical intervention and prognosis

et al. 2022

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Purpose It has been shown that abnormalities of coagulation and fibrinolysis system are involved in the pathogenesis of necrotizing enterocolitis (NEC), but not well studied challenge in the context of early detection of disease progression. The present study mainly explores the predictive significance of coagulation parameters at the time of NEC diagnosis in identifying the patients who eventually received surgery and/or NEC-related deaths. Methods The retrospective study of 114 neonates with NEC was conducted with assessments of demographic data, laboratory results at the time of NEC diagnosis, treatment methods and prognosis. According to treatment methods, patients were divided into surgical intervention group and medical treatment group. Predictive factors were put forward and determined by receiver operating characteristic (ROC) curve analysis. An analysis of the surgical intervention and prognosis was performed. Results Of 114 patients, 46 (40.4%) cases received surgical intervention and 14 (12.3%) deaths. prothrombin time (PT), PT international normalized ratio, activated partial thromboplastin time (APTT), fibrinogen and platelet count at the time of NEC diagnosis were independently associated with surgical NEC. The APTT could identify patients at high risk for surgical NEC, with 67.39% sensitivity, 86.76% specificity, better than that of other serological parameters. Coagulopathy was found in 38.6% of all patients. For surgical intervention, the area under the ROC curve (AUC) of coagulopathy was 0.869 (95% confidence interval [CI]: 0.794 ~ 0.944, P < 0.001), with 82.61% sensitivity and 91.18% specificity, outperformed APTT (95% CI: 0.236 ~ 0.173, P = 0.001). Furthermore, the AUC for coagulopathy to predict mortality was 0.809 (95% CI: 0.725 ~ 0.877, P < 0.001), with 92.86% sensitivity and 69.0% specificity. Conclusion Coagulation parameters at the time of NEC diagnosis were conducive to early prediction of surgical NEC and -related deaths, which should be closely monitored in neonates at high risk of NEC and validated as a clinical decision-making tool.

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“…IP is one of the most devastating medical conditions that occurs in the NICU. Early diagnosis, swift judgment, and prompt surgical intervention are required to prevent severe complications and poor outcomes 41 . However, as we explained earlier, predicting the occurrence of IP is difficult.…”

Section: Discussionmentioning

confidence: 99%

Development of artificial neural networks for early prediction of intestinal perforation in preterm infants

Son

Kim

et al. 2022

Sci Rep

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Intestinal perforation (IP) in preterm infants is a life-threatening condition that may result in serious complications and increased mortality. Early Prediction of IP in infants is important, but challenging due to its multifactorial and complex nature of the disease. Thus, there are no reliable tools to predict IP in infants. In this study, we developed new machine learning (ML) models for predicting IP in very low birth weight (VLBW) infants and compared their performance to that of classic ML methods. We developed artificial neural networks (ANNs) using VLBW infant data from a nationwide cohort and prospective web-based registry. The new ANN models, which outperformed all other classic ML methods, showed an area under the receiver operating characteristic curve (AUROC) of 0.8832 for predicting IP associated with necrotizing enterocolitis (NEC-IP) and 0.8797 for spontaneous IP (SIP). We tested these algorithms using patient data from our institution, which were not included in the training dataset, and obtained an AUROC of 1.0000 for NEC-IP and 0.9364 for SIP. NEC-IP and SIP in VLBW infants can be predicted at an excellent performance level with these newly developed ML models. https://github.com/kdhRick2222/Early-Prediction-of-Intestinal-Perforation-in-Preterm-Infants.

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Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes

Cited by 27 publications

References 25 publications

Predictive Factors for Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

Predictive Factors for Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

Application of coagulation parameters at the time of necrotizing enterocolitis diagnosis in surgical intervention and prognosis

Development of artificial neural networks for early prediction of intestinal perforation in preterm infants

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