Li et al reported a nomogram for predicting the risk of fulminant necrotizing enterocolitis in a neonate. This can help to identify a patient who may require more aggressive management. The authors are from Zhengzhou University and Chongqing Medical University in China.
Patient selection: neonate with necrotizing enterocolitis
Parameters:
(1) assisted ventilation at NEC onset
(2) shock at NEC onset
(3) feeding volumes before onset at onset in mL per kg, from 0 to 240
(4) absolute neutrophil count at onset (day 0) in 10^9/L
(5) absolute neutrophil count on day 1 in 10^9/L
(6) absolute lymphocyte count on day 1 in 10^9/L
(7) absolute monocyte count on day 1 in 10^9/L
points for volume at onset =
= 39.2 - (0.16 * (volume))
points for absolute neutrophil count at onset =
= 100 - (1.82 * (ANC))
points for absolute neutrophil count on day 1 =
= 74.2 - (2.12 * (ANC))
points for absolute lymphocyte count on day 1 =
= 87.3 - (3.64 * (ALC))
points for absolute monocyte count on day 1 =
= 87.3 - (19.4 * (AMC))
|
Parameter
|
Finding
|
Points
|
|
ventilation
|
no
|
0
|
|
|
yes
|
18.4
|
|
shock
|
no
|
0
|
|
|
yes
|
13.6
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 420.1
• There is a sudden change in risk over the range from 320 to 400 points.
value of X =
= (0.08017 * (score)) - 28.95
probability of fulminant necrotizing enterocolitis =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.884.
