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Development of a Gestational Age-Specific Case Definition for Neonatal Necrotizing Enterocolitis
Cheryl Battersby1, Nick Longford1, Kate Costeloe2
1Neonatal Data Analysis Unit, Imperial College London, London, England.
JAMA Pediatrics
|January 4, 2017
Summary
A new gestational age-specific case definition for necrotizing enterocolitis (NEC) was developed. This standardized definition will improve research and care for this serious neonatal condition.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Clinical Epidemiology
Background:
- Necrotizing enterocolitis (NEC) is a significant cause of illness and death in newborns.
- Inconsistent case definitions hinder NEC research, surveillance, and quality improvement efforts.
Purpose of the Study:
- To establish a gestational age (GA)-specific case definition for NEC.
- To improve the accuracy and consistency of NEC diagnosis and reporting.
Main Methods:
- A prospective, 34-month population study was conducted in 163 English neonatal units.
- Logistic regression analysis was used to develop an ordinal NEC score and a dichotomous GA-specific case definition.
- Data included GA, birth weight z score, clinical findings, and abdominal radiography.
Main Results:
- The developed NEC score and case definition demonstrated good discrimination between infants with and without NEC (AUC 87% and 80%, respectively).
- The GA-specific case definition achieved a sensitivity of 66.2% and a specificity of 94.4%.
- The case definition showed good performance when applied to infants undergoing laparotomy.
Conclusions:
- Gestational age significantly influences NEC risk and clinical presentation.
- Implementing a standardized, GA-specific NEC case definition is crucial for advancing global efforts to reduce the burden of NEC.
- This standardized definition will enhance research, surveillance, and clinical management of NEC.
