Two evaluation systems for investigating operative indications of neonatal necrotizing enterocolitis

Abstract:

Objective：To investigate the BELL staging criteria and the frequency of seven clinical metrics of metabolic derangement （MD7），so as to evaluate the appropriate surgical intervention opportunity of neonatal necrotizing enterocolitis（NEC） for improving the accuracy of treatment. Methods：Clinical data of 209 NEC patients of our hospital from April 1st，2015 to October 1st，2018 were retrospectively analyzed and patients were grouped according to BELL staging criteria and frequency of MD7. Cure rate and mortality rate between groups were compared，and differences of conservative treatment effect and operative treatment effect in each group were analyzed. Results：Stage Ⅰ was mainly received conservative treatment. Improved stage Ⅱ was divided into ⅡA stage and ⅡB stage. There was no significant difference in cure rate and mortality rate between the conservative treatment effect and the operative effect in ⅡA stage，while cure rate was higher and mortality rate was lower in ⅡB stage. Ⅲ stage had a even higher cure rate and a even lower mortality rate. When MD7 frequency was less than 4，cure rate and mortality rate between conservative treatment and operative treatment had no statistically significant difference. When MD7 frequency was more than or equal to 4，the effect of operative treatment was significantly higher than that of conservative treatment. Meanwhile，when patients had stage ⅡB or above and MD7 frequency more than or equal to 4，the intestinal necrosis rate via operative exploration was nearly 100%. Conclusion：NEC patients，with improved BELL stage of ⅡB stage，should receive operative intervention actively；NEC children，with MD7 frequency≥4，should receive operative intervention actively. The results of the two evaluation systems of BELL staging criteria and MD7 frequency can be used as an important supplement to NEC operative indications except the absolutely indicated pneumoperitoneum，so as to seek a better long-term prognosis for patients.