title: A novel scoring system to predict the development of necrotizing enterocolitis totalis in premature infants.
abstract: OBJECTIVE
  Necrotizing enterocolitis totalis (NEC-totalis) is the severest form of NEC, with mortality rate of almost 100% even in the busiest neonatal centers. Despite such a prognosis, its risk factors remain elusive. We seek to identify clinical and laboratory parameters that differentiate NEC-totalis from NEC, and to use these factors to develop a scoring system to identify patients at risk for NEC-totalis upon presentation.
  
  
  METHODS
  NEC patients were identified from our electronic medical record using ICD9 code. Diagnosis of NEC-totalis was based on operative and autopsy reports. Patients were divided into 2 groups: NEC-but-no-totalis and NEC-totalis. Clinical/laboratory data were obtained for each group. T-test, multivariate logistic regression and backward stepwise regression analysis were performed to identify risk factors for NEC-totalis and these risk factors were formulated into a "Totalis Score."
  
  
  RESULTS
  Among 157 NEC patients, 13 had NEC-totalis. NEC-totalis patients, compared to NEC alone, had fewer platelets, older age at diagnosis of NEC and greater phosphorus and creatinine levels. A 0-5 point scale "Totalis Score" based on these risk factors had sensitivity of 92% and a specificity of 78% for the diagnosis of NEC-totalis.
  
  
  CONCLUSIONS
  Low platelet, high phosphorus, high creatinine and older age at diagnosis of NEC were associated with a greater risk of developing NEC-totalis.
authors: Division of Pediatric Surgery Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224.
authors: Shonan
authors: S
authors: Sho
authors: Division of Pediatric Surgery Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224.
authors: Matthew D
authors: MD
authors: Neal
authors: Division of Pediatric Surgery Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224.
authors: Jason
authors: J
authors: Sperry
authors: Division of Pediatric Surgery Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224. Electronic address: david.hackam@chp.edu.
authors: David J
authors: DJ
authors: Hackam
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D020345:Enterocolitis, Necrotizing / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis*; D008297:Male; D010758:Phosphorus / Q000097:blood; D010976:Platelet Count; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010758:Phosphorus; D003404:Creatinine
keywords: Bacteremia; Intestinal necrosis; Intestinal sepsis; NEC totalis; Necrotizing enterocolitis; Prematurity; Scoring systems