Skip to main content
SpringerLink
Log in

A Nomogram for Predicting Surgical Risk in Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study

  • Original Article
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To construct a nomogram that predicts the risk of surgery in patients with necrotizing enterocolitis (NEC).

Methods

This retrospective cohort study recruited patients diagnosed with NEC at the Children's Hospital of Soochow University from 2013 to 2023. The neonates were divided into conservative and surgical-treatment groups. Univariate and multivariate logistic regressions were performed to identify factors influencing surgical risk, and a predictive model was constructed.

Results

This study comprised 154 cases of NEC, 103 cases (66.9%) in the conservative group and 51 cases (33.1%) in the surgical group. Multivariate logistic regression analysis revealed that increased bloody stools [odds ratio (OR) 5.066; 95% confidence interval (CI) 1.7396–14.7532; p = 0.0029), oxygen inhalation (OR 1.8278; 95% CI 1.2113–2.7581; p = 0.0041), use of vasoconstrictors (OR 4.4446; 95% CI 1.7157–11.5137; p = 0.0021), portal venous gas (OR 4.5569; 95% CI 1.6324–12.7209; p = 0.0038), and blood sodium (OR 0.8339; 95% CI 0.7477–0.9301; p = 0.0011) were independent factors of surgical risk. The area under the nomogram's receiver operating characteristic (ROC) curve was 0.886. Decision curve analysis (DCA) and calibration curves demonstrated good predictive performance for the nomogram.

Conclusions

The nomogram effectively assessed the risk of surgical intervention in NEC patients, providing new insights and references for diagnosing and treating NEC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hackam D, Caplan M. Necrotizing enterocolitis: pathophysiology from a historical context. Semin Pediatr Surg. 2018;27:11–8.

    Article  PubMed  Google Scholar 

  2. Syed MK, Al Faqeeh AA, Saeed N, et al. Surgical versus medical management of necrotizing enterocolitis with and without intestinal perforation: a retrospective chart review. Cureus. 2021;13:e15722.

    PubMed  PubMed Central  Google Scholar 

  3. Ou J, Courtney CM, Steinberger AE, Tecos ME, Warner BW. Nutrition in necrotizing enterocolitis and following intestinal resection. Nutrients. 2020;12:520.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lin X, Zeng HP, Fang YF, Lin YY, Yang CY. Predictive indicators for necrotizing enterocolitis with the presence of portal venous gas and outcomes of surgical interventions. Front Pediatr. 2021;9:683510.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yu L, Liu C, Du Q, Ma L. Predictive factors for surgical intervention in neonates with necrotizing enterocolitis: a retrospective study. Front Surg. 2022;9:889321.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Li W, Zhang C, Li W, Qin F, Gao X, Xu F. Nomogram for predicting fulminant necrotizing enterocolitis. Pediatr Surg Int. 2023;39:154.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Lazow SP, Tracy SA, Staffa SJ, et al. Abdominal ultrasound findings contribute to a multivariable predictive risk score for surgical necrotizing enterocolitis: a pilot study. Am J Surg. 2021;222:1034–9.

    Article  PubMed  Google Scholar 

  8. Rao H, Xie Y, Zhou Y, Liao Z. Application of comprehensive score of risk factors to determine the best time for surgical intervention in neonatal necrotizing enterocolitis. J Paediatr Child Health. 2023;59:276–81.

    Article  PubMed  Google Scholar 

  9. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chetta KE, Vincent KG, Fanning B, et al. Impact of delayed time to antibiotics in medical and surgical necrotizing enterocolitis. Children. 2023;10:160.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pang KKY, Chao NSY, Wong BPY, Leung MWY, Liu KKW. The clip and drop back technique in the management of multifocal necrotizing enterocolitis: a single centre experience. Eur J Pediatr Surg. 2012;22:85–90.

    Article  CAS  PubMed  Google Scholar 

  12. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Esposito F, Mamone R, Di Serafino M, et al. Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg. 2017;7:336–44.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Askie LM, Darlow BA, Finer N, et al; Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration. Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration.. JAMA. 2018;319:2190–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Willis KA, Ambalavanan N. Necrotizing enterocolitis and the gut-lung axis. Semin Perinatol. 2021;45:151454.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gregory KE, Deforge CE, Natale KM, Phillips M, Van Marter LJ. Necrotizing enterocolitis in the premature infant: neonatal nursing assessment, disease pathogenesis, and clinical presentation. Adv Neonatal Care. 2011;11:155–64; quiz 65–6.

  17. Durrmeyer X, Marchand-Martin L, Porcher R, et al. Abstention or intervention for isolated hypotension in the first 3 days of life in extremely preterm infants: association with short-term outcomes in the EPIPAGE 2 cohort study. Arch Dis Child Fetal Neonatal Ed. 2017;102:490–6.

    Article  PubMed  Google Scholar 

  18. Wu TW, Noori S. Recognition and management of neonatal hemodynamic compromise. Pediatr Neonatol. 2021;62:S22–9.

    Article  PubMed  Google Scholar 

  19. Abboud B, El Hachem J, Yazbeck T, Doumit C. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol. 2009;15:3585–90.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cui M, Lu X. Portal venous gas. N Engl J Med. 2018;379:e37.

    Article  PubMed  Google Scholar 

  21. Ping AJ, Blane CE, Garver KA. Current prognosis in necrotizing enterocolitis with portal vein gas. Can Assoc Radiol J. 1998;49:237–40.

    CAS  PubMed  Google Scholar 

  22. Kennedy J, Holt CL, Ricketts RR. The significance of portal vein gas in necrotizing enterocolitis. Am Surg. 1987;53:231–4.

    CAS  PubMed  Google Scholar 

  23. Yuan K, Chen QQ, Zhu YL, Luo F. Hepatic portal venous gas without definite clinical manifestations of necrotizing enterocolitis in a 3-day-old full-term neonate: a case report. World J Clin Cases. 2021;9:9269–75.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Palleri E, Frimmel V, Fläring U, Bartocci M, Wester T. Hyponatremia at the onset of necrotizing enterocolitis is associated with intestinal surgery and higher mortality. Eur J Pediatr. 2022;181:1557–65.

    Article  PubMed  Google Scholar 

  25. Wu Z, Zhao L, Feng S, Luo J. Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: a retrospective cohort study. Int J Colorectal Dis. 2023;38:72.

    Article  PubMed  Google Scholar 

  26. Pintaldi S, Zago A, Pizzolon C, et al. Children with mild hyponatremia at the emergency department are at higher risk of hospitalization. BMC Pediatr. 2023;23:318.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Park SJ, Oh YS, Choi MJ, Shin JI, Kim KH. Hyponatremia may reflect severe inflammation in children with febrile urinary tract infection. Pediatr Nephrol. 2012;27:2261–7.

    Article  PubMed  Google Scholar 

  28. Swart RM, Hoorn EJ, Betjes MG, Zietse R. Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol. 2011;118:45–51.

    Article  PubMed  Google Scholar 

  29. Ahle M, Ringertz HG, Rubesova E. The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature. Eur Radiol. 2018;28:3621–31.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported in part by the Suzhou Newborn Surgery Medical Key Discipline Project (SZXK202105). The funding body assumed no role in the design of the study and collection, analysis, and interpretation of the data or in the writing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, Childrenʼs Hospital of Soochow University, Suzhou, 215025, China

    Lulu Chen, Wenxian Zhi, Shungen Huang & Jian Wang

Authors
  1. Lulu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenxian Zhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shungen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LC contributed to the conceptualization of this study; LC and WZ performed the data analyses; LC wrote the manuscript; JW and SH reviewed and edited the manuscript; and SH was responsible for project administration and funding acquisition. All authors have read and agreed to the published version of the manuscript. JW will act as guarantor for this manuscript.

Corresponding author

Correspondence to Jian Wang.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 12 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, L., Zhi, W., Huang, S. et al. A Nomogram for Predicting Surgical Risk in Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05091-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12098-024-05091-4

Keywords

Search

Navigation