Prediction of the need for surgery in infants with necrotizing enterocolitis: A systematic review and meta-analysis

Surgical necrotizing enterocolitis is associated with high rates of mortality and morbidity. However, there is a lack of consensus on the optimal candidates for surgical interventions. Accurate identification of the need for surgery is crucial for improving clinical outcome. The aim of this study was to evaluate the diagnostic performance of predictors of surgical intervention for neonates with necrotizing enterocolitis.

PubMed, Embase, and the Cochrane Database of Systematic Reviews were searched. We included studies that assessed the prediction of the need for surgical intervention in infants with necrotizing enterocolitis. We performed a meta-analysis of diagnostic accuracy of predictors (including clinical, laboratory, radiologic, and ultrasonographic parameters) by analyzing the pooled sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio and area under the receiver operating characteristic curve.

A total of 53 studies with 6,046 participants were included in this review. Pooled analyses were performed for 13 predictive factors. Abdominal distention had a high sensitivity (93%) and low specificity (26%), whereas abdominal wall erythema showed a low sensitivity (30%) and high specificity (93%). Thrombocytopenia was highly specific (85%) but poorly sensitive. Both signs of fixed intestinal loop and portal venous gas on radiography showed excellent specificities, although their sensitivities were poor. Ascites on sonography had a relatively good overall predictive performance with pooled area under the receiver operating characteristic curve of 0.84.

The diagnostic performance of the investigated predictors of surgical necrotizing enterocolitis varied greatly. Several predictors showed promise in identifying optimal candidates to receive surgery for necrotizing enterocolitis and appropriate integration of these parameters would be useful.