Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell's stages and biomarkers for NEC

Sheila M. Gephart, Phillip V. Gordon, Alexander H. Penn, Katherine E. Gregory, Jonathan R. Swanson, Akhil Maheshwari, Karl Sylvester

Research output: Contribution to journalArticle

Abstract

Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the “Two out of Three” rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC. NEC biomarkers include markers of inflammation, intestinal dysfunction, hematologic changes, and clinical features. Development and reporting of NEC biomarkers should be guided by the FDA's BEST Consensus resource, “Biomarkers, EndpointS, & other Tools” and consistently report metrics so that studies can be compared and results pooled. Current practice in the NICU would be enhanced by clinical tools that effectively inform the clinical team that a baby is at increasing risk of NEC. Ideally, these tools will incorporate both clinical information about the baby as well as molecular signals that are indicative of NEC. While meaningful biomarkers for NEC and clinical tools exist, translation into practice is mediocre.

Original languageEnglish (US)
Pages (from-to)3-10
Number of pages8
JournalSeminars in Pediatric Surgery
Volume27
Issue number1
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Biomarkers
Necrotizing Enterocolitis
Inflammation
Research

Keywords

  • Bell's stages
  • Biomarkers
  • Clinical definition
  • Clinical predictors
  • Necrotizing enterocolitis
  • Spontaneous intestinal perforation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Changing the paradigm of defining, detecting, and diagnosing NEC : Perspectives on Bell's stages and biomarkers for NEC. / Gephart, Sheila M.; Gordon, Phillip V.; Penn, Alexander H.; Gregory, Katherine E.; Swanson, Jonathan R.; Maheshwari, Akhil; Sylvester, Karl.

In: Seminars in Pediatric Surgery, Vol. 27, No. 1, 01.02.2018, p. 3-10.

Research output: Contribution to journalArticle

Gephart, Sheila M. ; Gordon, Phillip V. ; Penn, Alexander H. ; Gregory, Katherine E. ; Swanson, Jonathan R. ; Maheshwari, Akhil ; Sylvester, Karl. / Changing the paradigm of defining, detecting, and diagnosing NEC : Perspectives on Bell's stages and biomarkers for NEC. In: Seminars in Pediatric Surgery. 2018 ; Vol. 27, No. 1. pp. 3-10.
@article{9fcacc518fd54f3ab7154b83e4b7622b,
title = "Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell's stages and biomarkers for NEC",
abstract = "Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the “Two out of Three” rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC. NEC biomarkers include markers of inflammation, intestinal dysfunction, hematologic changes, and clinical features. Development and reporting of NEC biomarkers should be guided by the FDA's BEST Consensus resource, “Biomarkers, EndpointS, & other Tools” and consistently report metrics so that studies can be compared and results pooled. Current practice in the NICU would be enhanced by clinical tools that effectively inform the clinical team that a baby is at increasing risk of NEC. Ideally, these tools will incorporate both clinical information about the baby as well as molecular signals that are indicative of NEC. While meaningful biomarkers for NEC and clinical tools exist, translation into practice is mediocre.",
keywords = "Bell's stages, Biomarkers, Clinical definition, Clinical predictors, Necrotizing enterocolitis, Spontaneous intestinal perforation",
author = "Gephart, {Sheila M.} and Gordon, {Phillip V.} and Penn, {Alexander H.} and Gregory, {Katherine E.} and Swanson, {Jonathan R.} and Akhil Maheshwari and Karl Sylvester",
year = "2018",
month = "2",
day = "1",
doi = "10.1053/j.sempedsurg.2017.11.002",
language = "English (US)",
volume = "27",
pages = "3--10",
journal = "Seminars in Pediatric Surgery",
issn = "1055-8586",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Changing the paradigm of defining, detecting, and diagnosing NEC

T2 - Perspectives on Bell's stages and biomarkers for NEC

AU - Gephart, Sheila M.

AU - Gordon, Phillip V.

AU - Penn, Alexander H.

AU - Gregory, Katherine E.

AU - Swanson, Jonathan R.

AU - Maheshwari, Akhil

AU - Sylvester, Karl

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the “Two out of Three” rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC. NEC biomarkers include markers of inflammation, intestinal dysfunction, hematologic changes, and clinical features. Development and reporting of NEC biomarkers should be guided by the FDA's BEST Consensus resource, “Biomarkers, EndpointS, & other Tools” and consistently report metrics so that studies can be compared and results pooled. Current practice in the NICU would be enhanced by clinical tools that effectively inform the clinical team that a baby is at increasing risk of NEC. Ideally, these tools will incorporate both clinical information about the baby as well as molecular signals that are indicative of NEC. While meaningful biomarkers for NEC and clinical tools exist, translation into practice is mediocre.

AB - Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the “Two out of Three” rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC. NEC biomarkers include markers of inflammation, intestinal dysfunction, hematologic changes, and clinical features. Development and reporting of NEC biomarkers should be guided by the FDA's BEST Consensus resource, “Biomarkers, EndpointS, & other Tools” and consistently report metrics so that studies can be compared and results pooled. Current practice in the NICU would be enhanced by clinical tools that effectively inform the clinical team that a baby is at increasing risk of NEC. Ideally, these tools will incorporate both clinical information about the baby as well as molecular signals that are indicative of NEC. While meaningful biomarkers for NEC and clinical tools exist, translation into practice is mediocre.

KW - Bell's stages

KW - Biomarkers

KW - Clinical definition

KW - Clinical predictors

KW - Necrotizing enterocolitis

KW - Spontaneous intestinal perforation

UR - http://www.scopus.com/inward/record.url?scp=85034830223&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034830223&partnerID=8YFLogxK

U2 - 10.1053/j.sempedsurg.2017.11.002

DO - 10.1053/j.sempedsurg.2017.11.002

M3 - Article

C2 - 29275814

AN - SCOPUS:85034830223

VL - 27

SP - 3

EP - 10

JO - Seminars in Pediatric Surgery

JF - Seminars in Pediatric Surgery

SN - 1055-8586

IS - 1

ER -