German et al developed an index for evaluating neonates with necrotizing enterocolitis. This can help identify patients who require more aggressive management. The authors are from the University of California Irvine Medical Center in Orange, California.
Parameters:
(1) character of the stool
(2) abdominal findings on palpation
(3) X-ray evidence of pneumatosis intestinalis
(4) presence of pulmonary insufficiency (respiratory distress syndrome)
(5) duration of symptoms to the X-rays being positive
|
Parameter |
Finding |
Points |
|
character of the stool |
normal |
0 |
|
|
occult blood |
1 |
|
|
grossly bloody stools |
2 |
|
|
passage of tissue per rectum |
3 |
|
abdominal findings |
normal |
0 |
|
|
abdominal distension alone |
1 |
|
|
abdominal distension and tenderness |
2 |
|
|
acute abdomen with marked distension and extreme tenderness or erythema and pitting of the abdominal wall |
3 |
|
X-ray evidence of pneumatosis intestinalis |
none |
0 |
|
|
unilateral |
1 |
|
|
bilateral and/or portal vein gas |
2 |
|
|
free air |
3 |
|
pulmonary insufficiency |
normal cardiopulmonary function |
0 |
|
|
episodes of apnea and bradycardia |
1 |
|
|
episodes of apnea and bradycardia requiring bagging or increased oxygen |
2 |
|
|
respiratory insufficiency requiring intubation and mechanical ventilation |
3 |
|
duration of symptoms |
no symptoms |
0 |
|
|
> 24 hours |
1 |
|
|
12 - 24 hours |
2 |
|
|
< 12 hours |
3 |
total index =
= SUM(points for all 5 parameters)
Interpretation:
• minimum index: 0
• maximum index: 15
• The higher the index the more severe the disease.
|
Total Score |
Clinical Outcome |
|
0 |
normal |
|
1 - 4 |
subclinical benign disease |
|
5 - 10 |
medical group |
|
11 - 15 |
surgical group |
from Table 1, page 365
|
Total Score |
Mortality Rate |
|
0 |
0 |
|
1 - 10 |
7% |
|
11 -12 |
44% |
|
13 - 15 |
100% |
from Table 4, page 366
Limitations:
• The mortality rate hopefully has improved since 1979.
Specialty: Gastroenterology, Pedatrics
ICD-10: ,
