A scoping review of neonatal calf diarrhea case definitions

Various case descriptions and scoring systems have been used to define neonatal calf diarrhea (NCD) and diverse diarrhea-related outcomes are reported, which limits direct comparison between studies. Therefore, the objective of this scoping review was to characterize the case definitions used for NCD and describe diarrhea-related outcomes to inform future efforts towards standardization. A literature search identified articles using 3 databases (Medline, CAB Direct, Agricola), along with Google and Google Scholar. This returned 16,854 unique articles, which were then screened for eligibility by two independent reviewers, resulting in 555 being selected for data extraction. Among articles, the study populations included mostly dairy-breed calves (88%; n = 486) while the remainder evaluated beef, crossbred, or dual purpose beef/dairy calves (10%; n = 53), or did not report breed (3%; n = 16). Studies used between 1 and 8 metrics to define NCD, with 933 unique metrics extracted in total. The most common metric was fecal consistency alone (30%; n = 281), or with at least 1 other metric (26%; n = 241). To define diarrhea, fecal consistency was either described qualitatively (e.g., "profuse liquid feces"), or semi-quantitatively, for example using a scoring system that frequently included 4 levels (n = 208). Some NCD case definitions included fecal color, volume, or odor (10%; n = 98), physical exam parameters (8%; n = 79), the duration of abnormal feces (7%; n = 67), the presence of abnormal contents (e.g., blood, 7%; n = 61), farm treatment records (6%; n = 54), fecal dry matter (1%; n = 12), or another metric (4%; n = 41). One or more references were cited for the NCD case definition by 49% of studies (n = 273/555), with the most common references being Larson et al. (1977) (n = 85), and McGuirk (2008) (n = 59). In the 555 included articles, 979 unique diarrhea-related outcomes were found, most commonly a binary categorization of calves having or not having diarrhea (49%; n = 483). Other articles reported statistical outcomes calculated from fecal scores (16%; n = 159), multiple diarrhea severities (10%; n = 95), or the age calves first developed NCD (8%; n = 76). This review characterized substantial heterogeneity among NCD case definitions and diarrhea-related outcomes, which limits interpretation and comparison of studies. Future work is required to develop and validate reporting standards for NCD to optimize knowledge synthesis and support rigorous and ethical calf health research.