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

Shonan Sho, Matthew D. Neal, Jason Sperry, David J. Hackam

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1053-1056
Number of pages4
JournalJournal of pediatric surgery
Issue number7
StatePublished - Jul 2014
Externally publishedYes


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

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants'. Together they form a unique fingerprint.

Cite this