Prediction of GutCheckNEC and Its Relation to Severity of Illness and Measures of Deterioration in Necrotizing Enterocolitis

Abstract

Background: Necrotizing enterocolitis (NEC) risk has been shown to arise from multiple sources and risk awareness may be supported using bedside tools. Purpose: The purpose of this research was to examine the extent to which GutCheckNEC was associated with scores for clinical deterioration, severity of illness, and clinical outcome, and further to examine how scores might improve NEC prediction. Methods: A retrospective, correlational case-control study with infant data from 3 affiliated neonatal intensive care units was conducted. Results: Of 132 infants (44 cases, 88 controls), most were 28 weeks of gestation at birth and less (74%). Median age at NEC onset was 18 days (range: 6-34 days), with two-thirds diagnosed before 21 days. At 68 hours of life, higher GutCheckNEC scores were associated with NEC requiring surgery or resulting in death (relative risk ratio [RRR] = 1.06, P = .036), associations that persisted at 24 hours prior to diagnosis (RRR = 1.05, P = .046), and at the time of diagnosis (RRR = 1.05, P = .022) but showed no associations for medical NEC. GutCheckNEC scores were significantly correlated with pediatric early warning scores (PEWS) (r > 0.30; P < .005) and SNAPPE-II scores (r > 0.44, P < .0001). Increasing numbers of clinical signs and symptoms were positively associated with GutCheckNEC and PEWS at the time of diagnosis (r = 0.19, P = .026; and r = 0.25, P = .005, respectively). Implications for Practice and Research: GutCheckNEC provides structure to streamline assessment and communication about NEC risk. Yet, it is not intended to be diagnostic. Research is needed on how GutCheckNEC impacts timely recognition and treatment.