Albany Medical Center, Albany, NY, USA.
Golisano Children's Hospital, Rochester, NY, USA.
J Perinatol. 2018 Dec;38(12):1644-1650. doi: 10.1038/s41372-018-0245-1. Epub 2018 Oct 18.
To evaluate the utility of a standardized physical exam score (PE-NEC) in predicting need for surgery or death in neonates with necrotizing enterocolitis (NEC).
This prospective, multicenter, observational study was conducted from 3/1/14 to 2/29/16 with three regional perinatal centers in upstate New York. Infants with NEC Bell's Stage ≥ 2 had physical exams and laboratory data recorded at 12-24 h intervals for 48 h following diagnosis. PE-NEC score was comprised of seven components: bowel sounds, capillary refill time, abdominal wall erythema, girth, discoloration, induration, and tenderness. Surgical timing was determined by surgeons blinded to the PE-NEC score. Optimal sensitivity and specificity of PE-NEC score for surgery/death (primary outcome) was determined by receiver operating characteristic curve analysis.
Of 100 infants with NEC, 5 had pneumoperitoneum at diagnosis and were excluded yielding 95 for analyses. Of those, 35 infants experienced the primary outcome: 3 died from NEC prior to surgery and 32 had surgery (30 laparotomies, 2 drains). The PE-NEC score was found to be sensitive and specific for need for surgery/death (AUC = 0.89, 95% CI 0.82-0.97); a score of ≥3 had a sensitivity of 0.88 (95% CI 0.72-0.97), specificity of 0.81 (95% CI 0.69-0.90). All components of the PE-NEC score were more likely to be present among infants with surgical NEC or who died.
PE-NEC score is sensitive and specific in predicting need for surgery in infants with NEC and should be validated as a clinical decision-making tool.
评估标准化体格检查评分（PE-NEC）在预测新生儿坏死性小肠结肠炎（NEC）患者是否需要手术或死亡的作用。
本前瞻性、多中心、观察性研究于 2014 年 3 月 1 日至 2016 年 2 月 29 日在纽约州北部的三个区域性围产期中心进行。NEC 贝尔分期≥2 级的患儿在确诊后 48 小时内，每 12-24 小时进行体格检查并记录实验室数据。PE-NEC 评分由七个部分组成：肠鸣音、毛细血管再充盈时间、腹壁红斑、腹围、变色、硬结和压痛。手术时机由对 PE-NEC 评分不知情的外科医生决定。通过受试者工作特征曲线分析确定 PE-NEC 评分预测手术/死亡（主要结局）的最佳灵敏度和特异性。
100 例 NEC 患儿中，5 例在诊断时伴有气腹，排除后 95 例用于分析。其中，35 例患儿出现主要结局：3 例因 NEC 死亡而未手术，32 例行手术（30 例剖腹手术，2 例引流）。PE-NEC 评分对手术/死亡的需要具有敏感性和特异性（AUC=0.89，95%CI 0.82-0.97）；评分≥3 时，灵敏度为 0.88（95%CI 0.72-0.97），特异性为 0.81（95%CI 0.69-0.90）。所有 PE-NEC 评分的组成部分在需要手术的 NEC 患儿或死亡患儿中更常见。
PE-NEC 评分对预测 NEC 患儿是否需要手术具有敏感性和特异性，应作为临床决策工具进行验证。
