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Type: Journal article
Title: Diagnosis and management of necrotizing enterocolitis: an international survey of neonatologists and pediatric surgeons
Author: Valpacos, M.
Arni, D.
Keir, A.
Aspirot, A.
Wilde, J.
Beasley, S.
De Luca, D.
Pfister, R.
Karam, O.
Citation: Neonatology, 2018; 113(2):170-176
Publisher: KARGER
Issue Date: 2018
ISSN: 1661-7800
1661-7819
Statement of
Responsibility: 
Mélanie Valpacos, Delphine Arni, Amy Keir, Ann Aspirot, James C.H. Wilde, Spencer Beasley, Daniele De Luca, Riccardo E. Pfister, Oliver Karam
Abstract: Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies.To evaluate the parameters used to diagnose or exclude NEC, and to identify differences between neonatologists and pediatric surgeons.A scenario-based survey was sent to neonatologists and pediatric surgeons.173 physicians from 26 countries completed the survey (55% neonatologists and 45% pediatric surgeons). Bloody stools, abdominal tenderness, low platelet counts, and increased lactate levels increased the likelihood of NEC for 82, 72, 56, and 45% of respondents, respectively. Intestinal pneumatosis, portal venous gas, and pneumoperitoneum on X-ray increased the likelihood of NEC for 99, 98, and 92% of respondents, respectively. Clinical examination and laboratory tests were insufficient to exclude NEC, but normal intestinal movements and normal gut wall thickness on ultrasonography decreased the likelihood of NEC for 38 and 33% of respondents, respectively. Neonatologists more frequently relied on increased gastric residuals and abdominal distension to diagnose NEC (p = 0.04 and p = 0.03, respectively), whereas pediatric surgeons more frequently reported that absence of bloody stools helped to exclude NEC (p = 0.04). In a deteriorating patient with suspected NEC, 39% of respondents would broaden the antibiotic spectrum, and 42% would recommend a laparotomy.Our results indicate a wide variation in the management of NEC, with significant differences between neonatologists and pediatric surgeons. A better appreciation of the relative significance and weighting that should be applied to the clinical features and investigations should reduce the variation in interpretation that appears to exist.
Keywords: Clinical practice variability; Diagnosis; Necrotizing enterocolitis; Preterm infant; Treatment
Rights: © 2017 S. Karger AG, Basel
RMID: 0030079954
DOI: 10.1159/000484197
Appears in Collections:Medicine publications

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