Bell et al developed a clinical staging system for neonates with necrotizing enterocolitis (NEC). This can help identify neonates who require aggressive management and monitoring. The authors are from Washington University School of Medicine in St. Louis.
Clinical Diagnosis |
Stage |
no evidence of NEC |
0 |
NEC suspected |
I |
definite NEC |
II |
advanced NEC |
III |
General features shared by all stages:
(1) one or more historical factors associated with neonatal stress
(2) exclusion of other causes of gastrointestinal disease in neonates (malrotation, atresia, volvulus, Hirschsprung's disease, etc.)
Historical factors associated with NEC:
(1) small for gestational age or premature delivery
(2) pulmonary disease
(3) cardiopulmonary instability
(4) abnormal labor and delivery
(5) multiple births
(6) maternal and/or neonatal infection
(7) umbilical catheter
(8) exchange transfusion
Parameters:
(1) systemic manifestations
(2) gastrointestinal manifestations
(3) radiographic findings
Manifestations |
Stage I |
Stage II |
Stage III |
systemic |
temperature instability, lethargy, apnea, bradycardia |
|
deteriorating vital signs, septic shock |
gastrointestinal |
poor feeding, increasing pregavage residuals, emesis, mild abdominal distension, occult blood in stool or emesis |
persistent occult blood or gross GI bleeding, abdominal distension |
massive GI bleeding |
radiographic findings |
intestinal distension with mild ileus |
intestinal distension with more marked ileus, edema of bowel wall, "rigid" bowel loops, portal vein gas, pneumatosis intestinalis |
pneumo-peritoneum |
Specialty: Gastroenterology, Pedatrics
ICD-10: ,