Necrotizing enterocolitis (NEC) is a life threatening gastrointestinal disorder that can cause bowel inflammation in newborns. To help diagnose and classify NEC, doctors may use a variety of staging methods, such as the Bell staging method.
In necrotizing enterocolitis (NEC), bacteria invade a section of the gastrointestinal tract causing cellular damage and eventual death of the colon and intestine. NEC is common among premature infants during the second or third week of life. It is a major cause of gastrointestinal admissions in the neonatal intensive care unit (NICU).
This article explores the different staging methods for necrotizing enterocolitis, including symptoms and treatment options.
This is the stage of suspected NEC where symptoms indicate early onset gastrointestinal disease. These may include:
- bloody stools
- mild abdominal bloating
- slow heart rate
- unstable temperature
Stage 2 is the stage of confirmed NEC. Symptoms include all the stage 1 indicators and the following:
- lack of bowel sounds
- pain or tenderness in the abdomen
- low or no intestinal movement
- presence of gas-filled spaces in the intestinal walls
Stage 3, or advanced NEC, encompasses all stage 1 and stage 2 indicators, as well as:
- low blood pressure
- low white blood cell count
- blood clot formation
- inflammation of abdominal tissues
- buildup of fluid and gases in the abdominal cavity
Other NEC staging methods
Vermont Oxford Network (VON) definition
The VON criteria define NEC as a diagnosis at surgery, post-mortem examination, or based on clinical and radiographic criteria. According to VON criteria, infants must have a clinical sign in addition to one radiographic symptom.
Examples of clinical symptoms include:
- abdominal distension
- blood in stool
In addition, the following are the radiographic findings of the VON criteria:
- hepato-biliary gas
- pneumatosis intestinalis
Centers for Disease Control and Prevention (CDC)
While the CDC shares similar clinical and imaging symptoms with the VON definition, it has some slight modifications.
It also includes a surgical NEC criterion which
UK Neonatal Collaborative (UKNC-NEC)
This is a point-based, gestational, age-specific NEC classification system.
The NEC score range from
This is in addition to one or more radiographic signs. It also assigns 2 points for blood in the stool and 3 points for pneumatosis intestinalis.
Two of three rule
The doctor will diagnose NEC in a preterm infant if they have two of the
- pneumatosis or portal air by ultrasound or abdominal X-ray
- persistent platelet consumption
- postmenstrual age at disease onset more closely related to NEC than SIP
In addition to two of the above symptoms, they will also have one or more of the following:
- abdominal distention
- bloody stools
Stanford NEC score
The Stanford NEC score considers the following factors to generate a score. This
- baseline characteristics, which include postnatal age, gender, and ethnicity
- clinical factors, such as feeding intolerance
- clinical exam findings, which include discoloration of the abdominal wall
- laboratory test results, such as platelet count and PH value
- radiographic findings, such as portal venous gas or pneumatosis intestinalis
International Neonatal Consortium (INC)
This requires that infants satisfy
- intestinal necrosis at laparotomy
- pneumatosis intestinalis or portal venous air
- evidence of vasculitis
- coagulopathy or inflammation in the absence of a bacterial, fungal, or viral infection
According to the National Institute of Child Health and Human Development (NICHD), symptoms of NEC in a newborn include:
- bloody stool
- pain in the abdomen
- swollen abdomen
- inability to digest food
In an older baby or child, a doctor would usually suspect a different diagnosis.
Due to its fast progression, medical professionals recommend early diagnosis at the first stage. If a parent or caregiver notices symptoms of NEC in an infant, they should contact the doctor immediately. NEC often occurs when a baby is still in the NICU.
NEC treatment options depend on the stage. The doctor will evaluate a person’s symptoms and disease progression before recommending a treatment option. This
- stopping all tube feeding
- nasogastric intubation to decompress dilated bowels
- intravenous antibiotics, such as ampicillin, gentamicin, or metronidazole
- total parenteral or intravenous nutrition while the infant receives no food by mouth
- laparotomy, which is the surgical removal of the damaged sections of the intestine
- peritoneal drainage if the infant cannot tolerate surgery
Necrotizing enterocolitis (NEC) is a life threatening condition that occurs due to inflammation in the intestine.
To guide appropriate treatment, medical experts have developed different staging methods to help clinicians accurately diagnose NEC. This includes the CDC, VON, UKNC, two of three rule, and Stanford definitions.
Without treatment, NEC can progress rapidly, causing gastrointestinal perforation and death.