Top

Pediatric Surgery International

Published in:

Open Access 01-12-2023 | Shock | Original Article

Nomogram for predicting fulminant necrotizing enterocolitis

Authors: Weibo Li, Chen Zhang, Wenli Li, Fanyue Qin, Xiang Gao, Falin Xu

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Background

Fulminant necrotizing enterocolitis (FNEC) is the most serious subtype of NEC and has a high mortality rate and a high incidence of sequelae. Onset prediction can help in the establishment of a customized treatment strategy. This study aimed to develop and evaluate a predictive nomogram for FNEC.

Methods

We conducted a retrospective observation to study the clinical data of neonates diagnosed with NEC (Bell stage ≥ IIB). Neonates were divided into the FNEC and NEC groups. A multivariate logistic regression model was used to construct the nomogram model. The performance of the nomogram was assessed using area under the curve, calibration analysis, and decision curve analysis.

Results

A total of 206 neonate cases were included, among which 40 (19.4%) fulfilled the definition of FNEC. The identified predictors were assisted ventilation after NEC onset; shock at NEC onset; feeding volumes before NEC onset; neutrophil counts on the day of NEC onset; and neutrophil, lymphocyte, and monocyte counts on day 1 after NEC onset. The nomogram exhibited good discrimination, with an area under the receiver operating characteristic curve of 0.884 (95% CI 0.825–0.943). The predictive model was well calibrated. Decision curve analysis confirmed the clinical usefulness of this nomogram.

Conclusion

A nomogram with a potentially effective application was developed to facilitate the individualized prediction of FNEC, with the hope of providing further direction for the early diagnosis of FNEC and timing of intervention.

Available only for authorised users

Jiang S, Yan W, Li S, Zhang L, Zhang Y, Shah PS et al (2020) Mortality and morbidity in infants <34 weeks’ gestation in 25 nicus in china: a prospective cohort study. Front Pediatr 8:33. https://doi.org/10.3389/fped.2020.00033CrossRefPubMedPubMedCentral

Eaton S, Rees CM, Hall NJ (2017) Current research on the epidemiology, pathogenesis, and management of necrotizing enterocolitis. Neonatology 111:423–430. https://doi.org/10.1159/000458462CrossRefPubMed

Jones IH, Hall NJ (2020) Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review. J Pediatr 220:86-92.e3. https://doi.org/10.1016/j.jpeds.2019.11.011CrossRefPubMed

Dukleska K, Devin CL, Martin AE, Miller JM, Sullivan KM, Levy C et al (2019) Necrotizing enterocolitis totalis: high mortality in the absence of an aggressive surgical approach. Surgery 165:1176–1181. https://doi.org/10.1016/j.surg.2019.03.005CrossRefPubMed

Hummer P, Klein P, Mang K (1986) Procedures in fulminant courses of necrotizing enterocolitis. Langenbecks Arch Chir 369:673–676. https://doi.org/10.1007/bf01274459CrossRefPubMed

Garg PM, O’Connor A, Ansari MAY, Vu B, Hobart H, Paschal JL et al (2021) Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis. J Perinatol 41:1110–1121. https://doi.org/10.1038/s41372-021-01044-3CrossRefPubMedPubMedCentral

Hartman HA, Pennell C, Aronoff S, Arthur LG (2021) Effect of feeding strategies on the development of fulminant necrotizing enterocolitis. Eur J Pediatr Surg 31:49–53. https://doi.org/10.1055/s-0040-1715613CrossRefPubMed

Khalak R, Chess PR (1998) Fulminant necrotizing enterocolitis in a premature neonate treated for supraventricular tachycardia. J Perinatol 18:306–307PubMed

Hawkes CP, Adzick NS, Palladino AA, De León DD (2016) Late presentation of fulminant necrotizing enterocolitis in a child with hyperinsulinism on octreotide therapy. Horm Res Paediatr 86:131–136. https://doi.org/10.1159/000443959CrossRefPubMed

10.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228. https://doi.org/10.1007/s00134-012-2769-8CrossRefPubMedPubMedCentral

11.

Cheng Q, Zhang H, Shang Y, Zhao Y, Zhang Y, Zhuang D et al (2021) Clinical features and risk factors analysis of bronchitis obliterans due to refractory Mycoplasma pneumoniae pneumonia in children: a nomogram prediction model. BMC Infect Dis 21:1085. https://doi.org/10.1186/s12879-021-06783-4CrossRefPubMedPubMedCentral

12.

Shen Y, Zhou Y, Ma C, Liu Y, Wei B (2021) Establishment of a predictive nomogram and its validation for severe adenovirus pneumonia in children. Ann Palliat Med 10:7194–7204. https://doi.org/10.21037/apm-21-675CrossRefPubMed

13.

Yang S, Su T, Huang L, Feng LH, Liao T (2021) A novel risk-predicted nomogram for sepsis associated-acute kidney injury among critically ill patients. BMC Nephrol 22:173. https://doi.org/10.1186/s12882-021-02379-xCrossRefPubMedPubMedCentral

14.

Van Calster B, Wynants L, Verbeek JFM, Verbakel JY, Christodoulou E, Vickers AJ et al (2018) Reporting and interpreting decision curve analysis: a guide for investigators. Eur Urol 74:796–804. https://doi.org/10.1016/j.eururo.2018.08.038CrossRefPubMedPubMedCentral

15.

Lin L, Xia X, Liu W, Wang Y, Hua Z (2019) Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children’s hospital in the last 10 years. PLoS ONE 14:e0224880. https://doi.org/10.1371/journal.pone.0224880CrossRefPubMedPubMedCentral

16.

Deshpande SA, Platt MP (1997) Association between blood lactate and acid-base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed 76:F15-20. https://doi.org/10.1136/fn.76.1.f15CrossRefPubMedPubMedCentral

17.

Surmeli Onay O, Korkmaz A, Yigit S, Yurdakok M (2020) Hypoxic-ischemic enterocolitis: a proposal of a new terminology for early NEC or NEC-like disease in preterm infants, a single-center prospective observational study. Eur J Pediatr 179:561–570. https://doi.org/10.1007/s00431-019-03539-wCrossRefPubMed

18.

Srinivasjois R, Nathan E, Doherty D, Patole S (2010) Prediction of progression of definite necrotising enterocolitis to need for surgery or death in preterm neonates. J Matern Fetal Neonatal Med 23:695–700CrossRefPubMed

19.

Lambert DK, Christensen RD, Baer VL, Henry E, Gordon PV, Besner GE et al (2012) Fulminant necrotizing enterocolitis in a multihospital healthcare system. J Perinatol 32:194–198. https://doi.org/10.1038/jp.2011.61CrossRefPubMed

20.

Patel CC (1977) Hematologic abnormalities in acute necrotizing enterocolitis. Pediatr Clin North Am 24:579–584. https://doi.org/10.1016/s0031-3955(16)33466-6CrossRefPubMed

21.

Fournier BM, Parkos CA (2012) The role of neutrophils during intestinal inflammation. Mucosal Immunol 5:354–366. https://doi.org/10.1038/mi.2012.24CrossRefPubMed

22.

Klinke M, Vincent D, Trochimiuk M, Appl B, Tiemann B, Reinshagen K et al (2020) Development of an improved murine model of necrotizing enterocolitis shows the importance of neutrophils in NEC pathogenesis. Sci Rep 10:8049. https://doi.org/10.1038/s41598-020-65120-yCrossRefPubMedPubMedCentral

23.

Egan CE, Sodhi CP, Good M, Lin J, Jia H, Yamaguchi Y et al (2016) Toll-like receptor 4-mediated lymphocyte influx induces neonatal necrotizing enterocolitis. J Clin Invest 126:495–508. https://doi.org/10.1172/JCI83356CrossRefPubMed

24.

Desiraju S, Bensadoun J, Bateman D, Kashyap S (2020) The role of absolute monocyte counts in predicting severity of necrotizing enterocolitis. J Perinatol 40:922–927. https://doi.org/10.1038/s41372-020-0596-2CrossRefPubMedPubMedCentral

25.

Namachivayam K, MohanKumar K, Shores DR, Jain SK, Fundora J et al (2020) Targeted inhibition of thrombin attenuates murine neonatal necrotizing enterocolitis. Proc Natl Acad Sci USA 117:10958–10969. https://doi.org/10.1073/pnas.1912357117CrossRefPubMedPubMedCentral

26.

Thompson AM, Bizzarro MJ (2008) Necrotizing enterocolitis in newborns: pathogenesis, prevention and management. Drugs 68:1227–1238. https://doi.org/10.2165/00003495-200868090-00004CrossRefPubMed

27.

Maheshwari A (2020) Role of platelets in neonatal necrotizing enterocolitis. Pediatr Res 89:1087–1093. https://doi.org/10.1038/s41390-020-1038-8CrossRefPubMedPubMedCentral

28.

Wang J, Yu J, Fan J, He Y, Dong W, Wang Z (2017) Evaluation of altitude-appropriate reference ranges for neutrophils in diagnosis of sepsis in very low birth weight infants: A multicenter retrospective study. PLoS ONE 12:e0171571. https://doi.org/10.1371/journal.pone.0171571CrossRefPubMedPubMedCentral

29.

Christensen RD, Baer VL, Gordon PV, Henry E, Whitaker C, Andres RL et al (2012) Reference ranges for lymphocyte counts of neonates: associations between abnormal counts and outcomes. Pediatrics 129:e1165–e1172. https://doi.org/10.1542/peds.2011-2661CrossRefPubMed

30.

Christensen RD, Jensen J, Maheshwari A, Henry E (2010) Reference ranges for blood concentrations of eosinophils and monocytes during the neonatal period defined from over 63 000 records in a multihospital health-care system. J Perinatol 30:540–545. https://doi.org/10.1038/jp.2009.196CrossRefPubMed

31.

Tröger B, Müller T, Faust K, Bendiks M, Bohlmann MK, Thonnissen S et al (2013) Intrauterine growth restriction and the innate immune system in preterm infants of ≤32 weeks gestation. Neonatology 103:199–204. https://doi.org/10.1159/000343260CrossRefPubMed

32.

Bæk O, Sangild PT, Thymann T, Nguyen DN (2019) Growth restriction and systemic immune development in preterm piglets. Front Immunol 10:2402. https://doi.org/10.3389/fimmu.2019.02402CrossRefPubMedPubMedCentral

33.

Hansen CF, Thymann T, Andersen AD, Holst JJ, Hartmann B, Hilsted L et al (2016) Rapid gut growth but persistent delay in digestive function in the postnatal period of preterm pigs. Am J Physiol Gastrointest Liver Physiol 310:G550–G560. https://doi.org/10.1152/ajpgi.00221.201CrossRefPubMedPubMedCentral

Title: Nomogram for predicting fulminant necrotizing enterocolitis
Authors: Weibo Li
Chen Zhang
Wenli Li
Fanyue Qin
Xiang Gao
Falin Xu
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Shock
Shock
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05435-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nomogram for predicting fulminant necrotizing enterocolitis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Anti-inflammatory effects of antenatal administration of stem cell derived extracellular vesicles in the brain of rat fetuses with congenital diaphragmatic hernia

Prognostic factors and outcomes of Kasai portoenterostomy (KPE): nine-year experience from a lower-middle income country

Management of sphincter insufficiency in patients with neurogenic bladder and bladder augmentation

Frequency of infiltrating regulatory T-cells in the portal tract of biliary atresia

The role of mini-PCNL as primary approach for the treatment of pediatric kidney stones in a high-income country. Ten-year single-center report

Assessment of the neonatal referral and transport system for patients with gastroschisis in Kenya