College of Nursing, The University of Arizona, Tucson (Drs Gephart and Rothers); Neonatal Intensive Care Clinical Nurse Specialist, Banner Health, Mesa, Arizona (Dr Fleiner); Karibu Family Care, Peoria, Arizona (Dr Msowoya); and StatLab BIO5 Institute, The University of Arizona, Tucson (Dr Rothers).
Adv Neonatal Care. 2023 Aug 1;23(4):377-386. doi: 10.1097/ANC.0000000000001080. Epub 2023 Jun 20.
Necrotizing enterocolitis (NEC) risk has been shown to arise from multiple sources and risk awareness may be supported using bedside tools.
The purpose of this research was to examine the extent to which GutCheck NEC was associated with scores for clinical deterioration, severity of illness, and clinical outcome, and further to examine how scores might improve NEC prediction.
A retrospective, correlational case-control study with infant data from 3 affiliated neonatal intensive care units was conducted.
Of 132 infants (44 cases, 88 controls), most were 28 weeks of gestation at birth and less (74%). Median age at NEC onset was 18 days (range: 6-34 days), with two-thirds diagnosed before 21 days. At 68 hours of life, higher GutCheck NEC scores were associated with NEC requiring surgery or resulting in death (relative risk ratio [RRR] = 1.06, P = .036), associations that persisted at 24 hours prior to diagnosis (RRR = 1.05, P = .046), and at the time of diagnosis (RRR = 1.05, P = .022) but showed no associations for medical NEC. GutCheck NEC scores were significantly correlated with pediatric early warning scores (PEWS) ( r > 0.30; P < .005) and SNAPPE-II scores ( r > 0.44, P < .0001). Increasing numbers of clinical signs and symptoms were positively associated with GutCheck NEC and PEWS at the time of diagnosis ( r = 0.19, P = .026; and r = 0.25, P = .005, respectively).
GutCheck NEC provides structure to streamline assessment and communication about NEC risk. Yet, it is not intended to be diagnostic. Research is needed on how GutCheck NEC impacts timely recognition and treatment.
坏死性小肠结肠炎（NEC）的风险来自多个来源，风险意识可以通过床边工具来支持。
本研究旨在探讨 GutCheck NEC 与临床恶化评分、疾病严重程度和临床结局的相关性，并进一步探讨评分如何提高 NEC 预测的准确性。
采用回顾性、相关性病例对照研究方法，收集了 3 家附属新生儿重症监护病房的婴儿数据。
在 132 名婴儿（44 例病例，88 例对照）中，大多数婴儿出生时胎龄为 28 周，不到 74%。NEC 发病的中位年龄为 18 天（范围：6-34 天），其中三分之二在 21 天前确诊。在出生后 68 小时，GutCheck NEC 评分较高与需要手术治疗或导致死亡的 NEC 相关（相对危险比 [RRR] = 1.06，P =.036），这些关联在诊断前 24 小时（RRR = 1.05，P =.046）和诊断时（RRR = 1.05，P =.022）仍然存在，但与非手术性 NEC 无关。GutCheck NEC 评分与儿科早期预警评分（PEWS）（ r > 0.30；P <.005）和 SNAPPE-II 评分（ r > 0.44，P <.0001）显著相关。在诊断时，临床体征和症状的数量增加与 GutCheck NEC 和 PEWS 呈正相关（ r = 0.19，P =.026；r = 0.25，P =.005）。
GutCheck NEC 为评估和沟通 NEC 风险提供了结构。然而，它并不是诊断性的。需要研究 GutCheck NEC 如何影响及时识别和治疗。
