Evaluation of a Clinical Risk Score for Preterm Necrotising Enterocolitis: The 'Check-NEC Score'.

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Clinical Risk Prediction

Background:

• Necrotising enterocolitis (NEC) poses a significant burden on preterm infants, necessitating early detection.
• Validating clinical risk scores is crucial for improving outcomes in very preterm infants.

Purpose of the Study:

• To validate the Check-NEC Score (CNS) for the early prediction of NEC in preterm infants.
• To assess the predictive performance of CNS at different time points before NEC diagnosis.

Main Methods:

• A case-control study involving very preterm infants (gestation < 32 weeks) with confirmed NEC (≥Stage II).
• CNS was calculated at baseline, 7 days (T2), and 72 hours (T3) prior to NEC diagnosis.
• Receiver operating characteristic (ROC) analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC).

Main Results:

• The median CNS was significantly higher in NEC cases compared to controls at T2 (p=0.025) and T3 (p=0.005).
• The T3 CNS achieved the highest AUC (0.64), indicating acceptable predictive ability.
• A CNS cut-off of ≥11 at T2 offered high specificity (95%), while scores of ≥8 or ≥9 at T3 were optimal.

Conclusions:

• The CNS demonstrates acceptable predictive performance for NEC in preterm infants, particularly at 72 hours prior to diagnosis.
• The score offers high specificity, aiding in early identification and management of NEC.
• The choice of cut-off score influences the balance between sensitivity and specificity for NEC prediction.