Necrotizing enterocolitis: current perspectives

Figures & data

Table 1 Epidemiological studies describing the incidence of necrotizing enterocolitis

Country	Study period	Infants (n)	Infant categorization	Incidence of NEC
Canada^Citation5	1996–1997	18,234	Birth weight
			<1,500 g, n=3,628	6.6% (< 1,500 g)
			>1,500 g, n= 14,606	0.7% (> 1,500 g)
New South Wales, Australia^Citation6	1994–1999	4,649	Gestation 24–31 weeks, n=4,649	3.8%
NICHD Neonatal	1998–2001	11,936	Birth weight
Network, USA^Citation7			<1,500 g, n=11,936	7.1%
UK^Citation8	2005–2006	10,946 (total NICU admissions)	Total n= 10,946 Birth weight 1,000 g, n=871 Gestation <26 weeks, n=386 26–28 weeks, n=656	2% 14.4% 13.8% 10.8%
Sweden^Citation9	2004–2007	497	Gestation <27 weeks, n=497	5.8%
Canada^Citation10	2003–2008	16,669	< 33 weeks	5.1%
Sweden^Citation11	1987–2009	2,381,318	Gestation <28 weeks, n=6,595 28–31 weeks, n= 14,822 Birth weight <750 g, n=2,768 750–999 g, n=3,793 1,000–1,499 g, n= 11,047	4.6% 1.4% 5.3% 4.1% 1.5%

Abbreviations: NEC, necrotizing enterocolitis; NICHD, National Institute of Child Health and Development; NICU, neonatal intensive care unit.

Figure 1 Pathogenesis of NEC.

Abbreviations: GI, gastrointestinal; NEC, necrotizing enterocolitis.

Table 2 Modified Bell’s staging system

Stage	Gastrointestinal signs	Systemic signs	Radiological findings
Stage IA	Increasing gastric aspirates, mild abdominal distension, fecal occult blood	Temperature instability, apnea, bradycardia, lethargy	Normal to mild ileus
Suspected NEC
Stage IB	As above plus fresh blood per-rectum	As above	As above
Suspected NEC
Stage IIA	As above plus absent bowel sounds on auscultation	As above	Intestinal dilatation, ileus, pneumatosis intestinalis
Confirmed NEC
Stage IIB	As above plus abdominal tenderness ± abdominal mass	As above plus mild metabolic acidosis and thrombocytopenia	As above plus portal vein gas and ascites
Confirmed NEC
Stage IIIA	As above plus marked distension and tenderness + generalised peritonitis	As above plus hypotension and severe apnea	As above
Advanced NEC
Stage IIIB	As above	As above	As above plus pneumoperitoneum
Advanced NEC

Notes: Adapted with permission from Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33(1):179–201.¹³¹ © 1986 Elsevier.

Abbreviation: NEC, necrotizing enterocolitis.

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