title: The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important.
  
  
  OBJECTIVE
  The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.
  
  
  METHODS
  A 3-site, descriptive correlational case-control design with retrospective data collection was used matching each NEC case to 2 controls (N = 132).
  
  
  RESULTS
  NEC cases were exposed to less human milk and fed later. Among them, 61% (n = 27) had at least 1 abdominal sign 36 hours before diagnosis, with fewer numbers having 2 (18%; n = 8) or 3 (5%; n = 2). At 36 hours before NEC, abdominal distension, duskiness, higher gastric residual, and greater count of abdominal signs were associated with severe NEC. No medical NEC cases had abdominal signs 36 or 24 hours before diagnosis. Highest severity of NEC was related to more abdominal signs at the times leading up to and at diagnosis of NEC. Gastric residuals were largely unrelated to NEC except for the most severe NEC at 36 hours before diagnosis.
  
  
  CONCLUSIONS
  Communicating a count of abdominal signs may support earlier recognition and treatment of NEC.
  
  
  CONCLUSIONS
  More research is needed to explore timing for clinical worsening of status (eg, surgical and NEC leading to death) and to study effective clinical approaches targeting early recognition to support timely action.
authors.affiliation: The University of Arizona College of Nursing, Tucson, Arizona (Drs Gephart and Kijewski); and Banner Health, Cardon Children's Medical Center, Mesa, Arizona (Dr Fleiner).
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Gephart
authors.forename: Michelle
authors.initials: M
authors.lastname: Fleiner
authors.forename: Amy
authors.initials: A
authors.lastname: Kijewski
mesh_terms: D000005:Abdomen; D016022:Case-Control Studies; D042241:Early Diagnosis; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D004890:Erythema / Q000175:diagnosis* / Q000209:etiology; D005247:Feeding Behavior; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies; D014839:Vomiting / Q000175:diagnosis* / Q000209:etiology