Rapidly progressive necrotizing enterocolitis: Risk factors and a predictive model

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Critical Care

Background:

• Rapidly progressive necrotizing enterocolitis (RP-NEC) is a severe subtype of necrotizing enterocolitis (NEC) with a high mortality rate.
• Limited research exists on predicting RP-NEC, highlighting the need for early identification strategies.

Purpose of the Study:

• To establish a predictive model for identifying infants with RP-NEC.
• To investigate risk factors associated with surgical intervention or death within 48 hours of NEC onset.

Main Methods:

• Retrospective single-center cohort study of newborn infants with NEC (Bell's stage ≥ IIB) from 2016-2023.
• Defined RP-NEC as the need for surgical intervention and/or death within 48 hours of NEC onset.
• Identified independent risk factors using statistical analysis.

Main Results:

• 82 out of 334 infants (24.6%) were diagnosed with RP-NEC.
• Independent risk factors for RP-NEC included low plasma sodium, elevated C-reactive protein, low platelet count, low lymphocyte count, acidosis (pH <7.2), and ascites.
• The predictive model demonstrated high accuracy with an AUC of 0.983.

Conclusions:

• A predictive model incorporating six key factors (plasma sodium, CRP, platelets, lymphocytes, blood gas pH, ascites) is highly effective for identifying RP-NEC.
• This model shows excellent calibration and is a promising tool for early detection and management of RP-NEC.