Defining necrotizing enterocolitis: current difficulties and future opportunities

Abstract

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in hospitalized infants. First classified through Bell staging in 1978, a number of additional definitions of NEC have been proposed in the subsequent decades. In this review, we summarize eight current definitions of NEC, and explore similarities and differences in clinical signs and radiographic features included within these definitions, as well as their limitations. We highlight the importance of a global consensus on defining NEC to improve NEC research and outcomes, incorporating input from participants at an international NEC conference. We also highlight the important role of patient-families in helping to redefine NEC.

Figure 1.. Comparison of risk group, exclusion criteria and systemic signs across NEC definitions

Abbreviations: UK, United Kingdom; VON, Vermont Oxford Network; CDC, Centers for Disease Control and Prevention; ST, Stanford; INC, International Neonatal Consortium; GA, gestational age; PMA, postmenstrual age; SIP, spontaneous intestinal perforation; DIC, disseminated intravascular coagulation ^a Modified Bell staging criteria did not specify a specific definition of “mild” acidosis, to differentiate from “acidosis”. In the ST NEC score, pH value was the most weighted predictor.

Figure 2.. Comparison of intestinal signs and radiologic findings across NEC definitions

Abbreviations: UK, United Kingdom; VON, Vermont Oxford Network; CDC, Centers for Disease Control and Prevention; ST, Stanford; INC, International Neonatal Consortium; GI, gastrointestinal. ^a Includes descriptions of bright blood from rectum, hematochezia or occult bleeding (without specific mention of testing for blood such as guaiac testing). ^b Includes descriptions of intestinal dilitation or distention ^c Also characterized as unchanged “rigid” loops of bowel ^d Caused by edema in bowel wall