Neonatal necrotizing enterocolitis is a severe acquired gastrointestinal disorder which affects neonates, especially those who are premature or of low birthweight. Neonates at increased risk can be identified by using a risk score based on clinical data.
Parameters:
(1) birthweight
(2) gestational age
(3) Apgar score
(4) need for supplemental oxygen and respiratory support
(5) hypotension
(6) presence of intraventricular hemorrhage and/or seizures
(7) presence of patent ductus arteriosus
(8) use of a catheter in an umbilical artery or vein
|
Parameter |
Finding |
Points |
|
birthweight |
< 1,000 grams |
2 |
|
|
1,000 - 1,500 grams |
1 |
|
|
> 1,500 grams |
0 |
|
gestational age |
<= 32 weeks |
1 |
|
|
> 32 weeks |
0 |
|
Apgar score at 5 minutes |
<= 5 (aka < 6) |
1 |
|
|
> 5 |
0 |
|
requires supplemental oxygen |
yes |
1 |
|
|
no |
0 |
|
requires respirator |
yes |
1 |
|
|
no |
0 |
|
blood pressure for age and weight |
low |
1 |
|
|
normal or high |
0 |
|
intraventricular hemorrhage or seizures |
yes |
1 |
|
|
no |
0 |
|
patent ductus arteriosus |
yes |
1 |
|
|
no |
0 |
|
umbilical artery or venous catheter |
yes |
1 |
|
|
no |
0 |
Variations:
• LaGamma et al (1985) gave an 1 point if supplemental oxygen or respiratory support was needed for > 2 days.
• LaGamma et al (1985) gave 1 point for umbilical artery catheter and 1 point for umbilical vein catheter. Ostertag et al (1986) gave 1 point if either was present.
risk score =
= SUM(points for all of the parameters)
Interpretation:
• minimum daily score: 0
• maximum daily score: 10 (assuming only 1 point for an umbilical vessel catheter and no points for duration of respiratory support)
• Ostertag et al (1986) used a score >= 6 at the end of the first 24 hours of life to identify high risk infants.
• LaGamma et al (1985) used a risk score using the sum of 3 consecutive daily scores. Their mean risk scores was 23-24 (Table 1, page 387).
Performance:
• McKeown et al (1994) found that the risk score was not an independent predictor for developing necrotizing enterocolitis, but did (1) identify infants more vulnerable to other risk factors and (2) indicate the prognosis if enterocolitis developed.
Specialty: Gastroenterology, Pedatrics
ICD-10: ,
