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Updated: Apr 15, 2026
A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis
Published on: November 30, 2021
Early Detection Tool of Intestinal Dysfunction: Impact on Necrotizing Enterocolitis Severity
Jenny R Fox1, Leroy R Thacker2, Karen D Hendricks-Muñoz1
1Division of Neonatal Medicine, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia.
Insights
An early warning tool using clinical signs effectively identifies intestinal dysfunction, reducing necrotizing enterocolitis (NEC) severity. Cardiorespiratory changes are the earliest indicators, preceding gastrointestinal symptoms.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Clinical Diagnostics
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition in premature infants.
- Early identification of intestinal dysfunction is crucial for timely intervention and improved outcomes.
- Current diagnostic methods may not always capture the earliest signs of NEC.
Purpose of the Study:
- To evaluate an early clinical signs and symptoms warning tool for identifying intestinal dysfunction.
- To assess the tool's effectiveness in decreasing the severity of necrotizing enterocolitis (NEC).
- To establish a clinical strategy for early NEC detection and management.
Main Methods:
- Development of the Neonatal Necrotizing Enterocolitis Early Detection Score (NeoNEEDS), a five-category scoring tool.
- Utilized signs and symptoms from 297 infants, including 33 with stage II/III NEC.
- Prospective cohort study of 72 infants (<1,500g) with 532 observations.
- Included behavior, cardiac, respiratory, gastrointestinal, and feeding tolerance assessments.
Main Results:
- Cardiorespiratory changes were the earliest indicators of intestinal dysfunction (Stage I NEC).
- Abdominal distension and feeding intolerance were late findings associated with advanced NEC stages.
- NeoNEEDS scores ≥5 accurately predicted intestinal dysfunction with high sensitivity (95%) and specificity (82%).
- Tool implementation correlated with reduced rates of Bell NEC stage II and III.
Conclusions:
- Cardiorespiratory symptoms reliably precede gastrointestinal signs of intestinal dysfunction.
- An early warning tool targeting specific signs and symptoms can mitigate NEC severity progression.
- The NeoNEEDS tool offers a promising strategy for early NEC detection in high-risk infants.
Objective:
The aim of this study is to determine the use of an early clinical signs and symptoms warning tool in early identification of intestinal dysfunction as a clinical strategy to decrease necrotizing enterocolitis (NEC) severity.
Design:
Using signs and symptoms of 297 infants, of which 33 infants were diagnosed with stage II and III EC intestinal dysfunction, a five clinical category scoring tool (Neonatal Necrotizing Enterocolitis Early Detection Score [NeoNEEDS]) and strategy with abdominal X-ray alert was developed. The categories included behavior, cardiac, respiratory, gastrointestinal, and feeding tolerance. The strategy was tested in a prospective cohort of 72 infants < 1,500 g, utilizing 532 observations between 10/2012 and 9/1/2013. The statistical analysis utilized the Statistical Analysis Software (SAS).
Results:
The earliest signs and symptoms of intestinal dysfunction (Stage I NEC) were cardiorespiratory baseline changes, p < 0.001. Abdominal distension and/or feeding intolerance were late findings associated with stage II or III NEC. Tool scores ≥ 5 predicted intestinal dysfunction (p < 0.00). Sensitivity was high (95%) with specificity of 82% and positive and negative predictive values of 76% and 95%, respectively. Use of the tool during the study period was associated with decreased NEC severity rates (Bell NEC stage II and III).
Conclusion:
Cardiorespiratory symptoms precede gastrointestinal symptoms of intestinal dysfunction. Targeting signs and symptoms in an early warning tool to identify intestinal dysfunction can impact NEC severity progression.
