Abstract
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 language | English (US) |
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Pages (from-to) | 1053-1056 |
Number of pages | 4 |
Journal | Journal of pediatric surgery |
Volume | 49 |
Issue number | 7 |
DOIs | |
State | Published - Jul 2014 |
Externally published | Yes |
Keywords
- Bacteremia
- Intestinal necrosis
- Intestinal sepsis
- NEC totalis
- Necrotizing enterocolitis
- Prematurity
- Scoring systems
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health