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  • Original Article
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Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

Journal of Perinatology volume 28, pages 665–674 (2008)Cite this article

Abstract

Objective:

Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.

Study Design:

This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.

Result:

Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52).

Conclusion:

Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.

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Acknowledgements

This study was supported in part by the Gerber Foundation and the Glaser Pediatric Research Network, an affiliate of the Elizabeth Glaser Pediatric AIDS Foundation.

The following persons and institutions have participated in this study: Bruna Banyas, RN, BSN, Monica Konstantino, RN, BSN, Joann Poulsen, RN, and Jan Taft, RN, BSN, Yale-New Haven Hospital; Geneva Shores, RN and Pam Gordon, RN, Texas Children's Hospital; Janet Mooney, RN, Department of Pediatrics, UCLA; Keniki McNeil, RN, Stanford University and Lucille Packard Children's Hospital; Carol Sweeney, BSN, Michael Wake, BA, and Laura Boger, BA, Children's Hospital, Boston; Marcia Wertz, RN, University of California Children's Hospital, San Francisco; Cami Martin, MD, Beth Israel Deaconess Medical Center, Boston. Moss, Kalish, Duggan, Johnston, Brandt, Dunn, Ehrenkranz, Jaksic, Nobuhara, Simpson, McCarthy and Sylvester have no financial disclosures to make regarding the contents and results of this study.

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    R L Moss & B J Simpson

  2. Clinical Research Program, Children's Hospital, Boston, MA, USA

    L A Kalish, P Johnston & M C McCarthy

  3. Division of GI/Nutrition, Children's Hospital, Boston, MA, USA

    C Duggan

  4. Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    M L Brandt

  5. Department of Surgery, University of California, Los Angeles, CA, USA

    J C Y Dunn

  6. Department of Bioengineering, University of California, Los Angeles, CA, USA

    J C Y Dunn

  7. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    R A Ehrenkranz

  8. Children's Hospital, Boston, MA, USA

    T Jaksic

  9. Department of Surgery, University of California, San Francisco, CA, USA

    K Nobuhara

  10. Department of Pediatrics, University of California, San Francisco, CA, USA

    K Nobuhara

  11. Department of OB-GYN, University of California, San Francisco, CA, USA

    K Nobuhara

  12. Department of Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, USA

    K G Sylvester

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  1. R L Moss
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  2. L A Kalish
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  3. C Duggan
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  5. M L Brandt
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  6. J C Y Dunn
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  9. K Nobuhara
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  11. M C McCarthy
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  12. K G Sylvester
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Correspondence to R L Moss.

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Moss, R., Kalish, L., Duggan, C. et al. Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study. J Perinatol 28, 665–674 (2008). https://doi.org/10.1038/jp.2008.119

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  • DOI: https://doi.org/10.1038/jp.2008.119

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