Modern necrotizing enterocolitis tools and their comparison

BACKGROUND AND OBJECTIVES: Necrotizing enterocolitis (NEC) is a significant gastrointestinal emergency that mostly affects premature infants, can cause mortality and morbidity due to intestinal ischemia, and can be complicated by sepsis and multiple organ failure. This situation has created a need for early diagnosis systems to detect and prevent NEC early. The aim of our prospective and single-center study was to test the power, validity and superiority of existing NEC scoring systems. It is the first study to be conducted for all scoring systems (eNEC, NeoNEEDS, GutCheckNEC, GutCheckNEC score for 1500 grams and below). METHODS: The prospective study included newborns who were born under 37 weeks of gestation and were admitted to our unit within the first 24 hours after birth in the Akdeniz University Medical Faculty Neonatal Intensive Care Unit during the one-year period between December 2022 and December 2023. Newborns who met at least one of the following criteria were excluded from the study: being term, having a chromosomal disease, being born with the need for abdominal surgery, not being admitted within the first 24 hours, having a right-to-left shunt or congenital heart disease with perfusion disorder, having a metabolic disease, being accepted as exitus within the first 48 hours of life, and having received hypoxic ischemic encephalopathy diagnosis and hypothermia treatment. Patients who were evaluated as Stage 1 NEC and feeding intolerance according to Bell criteria were also excluded. Statistical analysis was performed on 163 patients who met the criteria using descriptive data and scoring systems. RESULTS: Of the 163 patients included in the study, 73.6% (n=120) had a birth weight of over 1500 grams, while 26.4% (n=43) were born weighing 1500 grams or less. The gender distribution was 57.1% male (n=93) and 42.9% female (n=70). The mean gestational age was 32.72 weeks. Stage 2 and above NEC development was observed in only one patient (0.6%). The mortality rate was found to be 4.9% (n=8). Sepsis, hypotension, antibiotic use, PDA, umbilical catheterization, formula feeding, low gestational age, low birth weight, and late initiation of enteral feeding were found to be significantly associated with eNEC and NeoNEEDS scores. A positive correlation was found between eNEC and NeoNEEDS scores at each week. In the scoring system for GutCheckNEC <1500 grams, 43 patients were included, two patients had missing data and 41 patients were evaluated. Since a significant number could not be reached for statistical analysis, statistics could not be performed. CONCLUSION: A positive correlation was found between eNEC and NeoNEEDS scores every week. Low APGAR score, sepsis, hypotension, antibiotic use, PDA, umbilical catheterization, formula feeding, low gestational age, low birth weight, late start of enteral feeding are known as risk factors for NEC in the literature and were found to be associated with increasing scores in the scores. In addition, oral care with colostrum was found to be associated with low scores. Conducting future studies in a multicenter and longer time period may provide more valuable data. Keyword(s): Necrotizing Enterocolitis, NeoNEEDS, eNEC, GutCheckNEC, NEC, NEC scoring, NEC risk, Neonate