A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants

作者：Sho Shonan; Neal Matthew D; Sperry Jason; Hackam David J^*

来源：Journal of Pediatric Surgery, 2014, 49(7): 1053-1056.

DOI：10.1016/j.jpedsurg.2013.10.023

• Necrotizing enterocolitis
• NEC totalis
• Scoring systems
• Intestinal necrosis
• Prematurity
• Intestinal sepsis
• Bacteremia

Background/Purpose: Necrotizing enterocolitis totalis (NEC-totalis) is the severest form of NEC, with mortality rate of almost 100% even in the busiest neonatal centers. Despite such a prognosis, its risk factors remain elusive. We seek to identify clinical and laboratory parameters that differentiate NEC-totalis from NEC, and to use these factors to develop a scoring system to identify patients at risk for NEC-totalis upon presentation.
Method: NEC patients were identified from our electronic medical record using ICD9 code. Diagnosis of NEC-totalis was based on operative and autopsy reports. Patients were divided into 2 groups: NEC-but-no-totalis and NEC-totalis. Clinical/laboratory data were obtained for each group. T-test, multivariate logistic regression and backward stepwise regression analysis were performed to identify risk factors for NEC-totalis and these risk factors were formulated into a "Totalis Score."
Result: Among 157 NEC patients, 13 had NEC-totalis. NEC-totalis patients, compared to NEC alone, had fewer platelets, older age at diagnosis of NEC and greater phosphorus and creatinine levels. A 0-5 point scale "Totalis Score" based on these risk factors had sensitivity of 92% and a specificity of 78% for the diagnosis of NEC-totalis.
Conclusion: Low platelet, high phosphorus, high creatinine and older age at diagnosis of NEC were associated with a greater risk of developing NEC-totalis.

• 出版日期2014-7