title: Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study.
abstract: OBJECTIVE
  Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.
  
  
  METHODS
  This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.
  
  
  RESULTS
  Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52).
  
  
  CONCLUSIONS
  Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. larry.moss@yale.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Moss
authors.forename: L A
authors.initials: LA
authors.lastname: Kalish
authors.forename: C
authors.initials: C
authors.lastname: Duggan
authors.forename: P
authors.initials: P
authors.lastname: Johnston
authors.forename: M L
authors.initials: ML
authors.lastname: Brandt
authors.forename: J C Y
authors.initials: JC
authors.lastname: Dunn
authors.forename: R A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: T
authors.initials: T
authors.lastname: Jaksic
authors.forename: K
authors.initials: K
authors.lastname: Nobuhara
authors.forename: B J
authors.initials: BJ
authors.lastname: Simpson
authors.forename: M C
authors.initials: MC
authors.lastname: McCarthy
authors.forename: K G
authors.initials: KG
authors.lastname: Sylvester
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome