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J Perinatol. 2018 Dec;38(12):1644-1650. doi: 10.1038/s41372-018-0245-1. Epub 2018 Oct 18.

Physical examination score predicts need for surgery in neonates with necrotizing enterocolitis.

Author information

1
Albany Medical Center, Albany, NY, USA. Khalakr@amc.edu.
2
Golisano Children's Hospital, Rochester, NY, USA.
3
Children's Hospital of Buffalo, Buffalo, NY, USA.
4
Cohen Children's Medical Center, New Hyde Park, NY, USA.

Abstract

OBJECTIVE:

To evaluate the utility of a standardized physical exam score (PE-NEC) in predicting need for surgery or death in neonates with necrotizing enterocolitis (NEC).

METHODS:

This prospective, multicenter, observational study was conducted from 3/1/14 to 2/29/16 with three regional perinatal centers in upstate New York. Infants with NEC Bell's Stage ≥ 2 had physical exams and laboratory data recorded at 12-24 h intervals for 48 h following diagnosis. PE-NEC score was comprised of seven components: bowel sounds, capillary refill time, abdominal wall erythema, girth, discoloration, induration, and tenderness. Surgical timing was determined by surgeons blinded to the PE-NEC score. Optimal sensitivity and specificity of PE-NEC score for surgery/death (primary outcome) was determined by receiver operating characteristic curve analysis.

RESULTS:

Of 100 infants with NEC, 5 had pneumoperitoneum at diagnosis and were excluded yielding 95 for analyses. Of those, 35 infants experienced the primary outcome: 3 died from NEC prior to surgery and 32 had surgery (30 laparotomies, 2 drains). The PE-NEC score was found to be sensitive and specific for need for surgery/death (AUC = 0.89, 95% CI 0.82-0.97); a score of ≥3 had a sensitivity of 0.88 (95% CI 0.72-0.97), specificity of 0.81 (95% CI 0.69-0.90). All components of the PE-NEC score were more likely to be present among infants with surgical NEC or who died.

CONCLUSION:

PE-NEC score is sensitive and specific in predicting need for surgery in infants with NEC and should be validated as a clinical decision-making tool.

PMID:
30337731
DOI:
10.1038/s41372-018-0245-1
[Indexed for MEDLINE]

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