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Am J Perinatol 2024; 41(12): 1714-1727
DOI: 10.1055/a-2253-8656
Original Article

Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

Sujir P. Nayak
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Mariela Sánchez-Rosado
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
2   Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
,
Jordan D. Reis
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
3   Department of Pediatrics, Baylor Scott and White, Dallas, Texas
,
L. Steven Brown
4   Department of Research, Parkland Health and Hospital System, Dallas, Texas
,
Kate L. Mangona
5   Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Priya Sharma
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
3   Department of Pediatrics, Baylor Scott and White, Dallas, Texas
,
David B. Nelson
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
,
Myra H. Wyckoff
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Samir Pandya
7   Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Imran N. Mir
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Luc P. Brion
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Funding None.
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Abstract

Objective No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week.

Study Design This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birth weight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA score (Hyperglycemia, Hyperkalemia, use of inotropes for Hypotension during the prior week, Acidemia, Neonatal Sequential Organ Failure Assessment [nSOFA] score) was compared with a similar model using the nSOFA score.

Results Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively.

Conclusion Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC.

Key Points

  • No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.

  • In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).

  • The HASOFA-model had high discrimination (AUC: 0.909) and excellent calibration and was internally validated.

Keywords

birth weight - pneumoperitoneum - hyperkalemia - area under the curve - receiver operating characteristic curve - infant - newborn - diseases - sepsis - hypotension - hyperglycemia - mortality - cohort

Note

Sujir Pritha Nayak, Imran Mir, Mariela Sanchez-Rosado, Jordan D. Reis, Kate L. Mangona, David B. Nelson, Myra H. Wyckoff, Patti J. Burchfield, Anita Thomas, Polienna Sepulveda, Priya Sharma, Luc P. Brion. Predicting surgical necrotizing enterocolitis (NEC) and mortality among preterm infants suspected of NEC. Presented as poster at the Meeting of the Pediatric Academy Societies, Washington, DC, on April 29, 2023.


Availability of Data and Material

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


Authors' Contributions

L.P.B. and S.P.N. wrote the first version of the manuscript. L.P.B. and L.S.B. performed the statistical analyses. All authors participated in the study design, data collection, data interpretation, and revision and approval of the final version of the manuscript.


Patient Consent

UTSW IRB waived the need for individual consent.


Supplementary Material



Publication History

Received: 21 November 2023

Accepted: 23 January 2024

Accepted Manuscript online:
25 January 2024

Article published online:
20 February 2024

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