Subscribe to RSS
Are Scores Reliable in Predicting the Need for Surgery and Mortality in Necrotizing Enterocolitis?
27 June 2016
15 August 2016
05 October 2016 (online)
Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Various scores try to facilitate therapeutic decision-making. We aim to assess the agreement of three scores intending to predict the need for surgery and/or mortality in our patient cohort, and analyze agreement between the different scores.
Methods This study is a retrospective analysis of patients with NEC Bell's stage II and III, managed in a single institution (1991–2011). Three existing scores (Metabolic Derangement Acuity score, NEC score, Detroit score) were calculated individually for each patient. The agreement between predicted outcome by scores and real outcome was evaluated with kappa statistic.
Results Of 57 children, 46% presented with NEC stage II, 54% with stage III, 46% were treated with surgery, 54% conservatively, and survival was 58%. The kappa indexes for “need for surgery” were 0.41, 0.13, and 0.12 and kappa indexes for “mortality” were 0.27, 0.04, and 0.1 for the Metabolic Derangement Acuity score, the NEC score, and the Detroit score, respectively.
Conclusion In our cohort, the agreement between the predicted outcomes by scores and the real need for surgery and/or mortality was poor. There was a lack of clinical usefulness of the tested scores. We must continue to better identify parameters to help guide the management of these patients.
- 1 Hull MA, Fisher JG, Gutierrez IM. , et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg 2014; 218 (06) 1148-1155
- 2 Patel RM, Kandefer S, Walsh MC. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015; 372 (04) 331-340
- 3 Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK. ; Canadian Neonatal Network. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 2012; 129 (02) e298-e304
- 4 Papillon S, Castle SL, Gayer CP, Ford HR. Necrotizing enterocolitis: contemporary management and outcomes. Adv Pediatr 2013; 60 (01) 263-279
- 5 Pierro A, Hall N. Surgical treatments of infants with necrotizing enterocolitis. Semin Neonatol 2003; 8 (03) 223-232
- 6 Zani A, Eaton S, Puri P. , et al; EUPSA Network. International survey on the management of necrotizing enterocolitis. Eur J Pediatr Surg 2015; 25 (01) 27-33
- 7 Kessler U, Mungnirandr A, Nelle M, Nimmo AF, Zachariou Z, Berger S. A simple presurgical necrotizing enterocolitis-mortality scoring system. J Perinatol 2006; 26 (12) 764-768
- 8 Tepas III JJ, Sharma R, Leaphart CL, Celso BG, Pieper P, Esquivia-Lee V. Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement. J Pediatr Surg 2010; 45 (02) 310-313 , discussion 313–314
- 9 Bonnard A, Zamakhshary M, Ein S, Moore A, Kim PCW. The use of the score for neonatal acute physiology-perinatal extension (SNAPPE II) in perforated necrotizing enterocolitis: could it guide therapy in newborns less than 1500 g?. J Pediatr Surg 2008; 43 (06) 1170-1174
- 10 Ibáñez V, Couselo M, Marijuán V, Vila JJ, García-Sala C. Could clinical scores guide the surgical treatment of necrotizing enterocolitis?. Pediatr Surg Int 2012; 28 (03) 271-276
- 11 Sho S, Neal MD, Sperry J, Hackam DJ. A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants. J Pediatr Surg 2014; 49 (07) 1053-1056
- 12 Ji J, Ling XB, Zhao Y. , et al. A data-driven algorithm integrating clinical and laboratory features for the diagnosis and prognosis of necrotizing enterocolitis. PLoS ONE 2014; 9 (02) e89860
- 13 Fox JR, Thacker LR, Hendricks-Muñoz KD. Early detection tool of intestinal dysfunction: impact on necrotizing enterocolitis severity. Am J Perinatol 2015; 32 (10) 927-932
- 14 Munaco AJ, Veenstra MA, Brownie E, Danielson LA, Nagappala KB, Klein MD. Timing of optimal surgical intervention for neonates with necrotizing enterocolitis. Am Surg 2015; 81 (05) 438-443
- 15 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 16 Walsh MC, Kliegman R. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 179-201
- 17 Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37 (05) 360-363
- 18 Horbar JD, Carpenter JH, Badger GJ. , et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012; 129 (06) 1019-1026
- 19 Johnson TJ, Patel AL, Jegier BJ, Engstrom JL, Meier PP. Cost of morbidities in very low birth weight infants. J Pediatr 2013; 162 (02) 243-49.e1
- 20 Obladen M. Necrotizing enterocolitis—150 years of fruitless search for the cause. Neonatology 2009; 96 (04) 203-210
- 21 Caplan M, Frost B. Myth: necrotizing enterocolitis: probiotics will end the disease, and surgical intervention improves the outcome. Semin Fetal Neonatal Med 2011; 16 (05) 264-268
- 22 Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anest Anal 1953; 32 (04) 260-267
- 23 Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15 (05) 557-564
- 24 Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. ; Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP). PELOD-2: an update of the Pediatric logistic organ dysfunction score. Crit Care Med 2013; 41 (07) 1761-1773