Defining necrotizing enterocolitis: current difficulties and future opportunities

Abstract

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in hospitalized infants. First classified through Bell staging in 1978, a number of additional definitions of NEC have been proposed in the subsequent decades. In this review, we summarize eight current definitions of NEC, and explore similarities and differences in clinical signs and radiographic features included within these definitions, as well as their limitations. We highlight the importance of a global consensus on defining NEC to improve NEC research and outcomes, incorporating input from participants at an international NEC conference. We also highlight the important role of patient-families in helping to redefine NEC.

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Fig. 1: Comparison of risk group, exclusion criteria, and systemic signs across NEC definitions.
Fig. 2: Comparison of intestinal signs and radiologic findings across NEC definitions.

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Acknowledgements

R.M.P. received funding from the NIH under awards: KL2 TR000455, UL1 TR000454, and K23 HL128942. The NIH had no role in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. Publication of this article was sponsored by the Necrotizing Enterocolitis (NEC) Society, Patient-Centered Outcomes Research Institute, and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development under award number R13 HD098853.

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R.M.P., J.F., S.J.M., M.K., and M.S.C. all made substantial contributions to conception of the article, drafting the article, critical revisions, and approve of the final version to be published.

Corresponding author

Correspondence to Ravi Mangal Patel.

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Competing interests

R.M.P. has received honoraria and travel support from Mednax, Inc., partial travel support from Danone Nutricia to attend a meeting, and consulted for Shipman & Goodwin, LLP and serves on the data-monitoring committee of the Connection Study conducted by Premier Research/Infant Bacterial Therapeutics. None of these entities had any role in this manuscript. S.J.M. received lecture fees from Abbott, grant support from Evolve Biosystems and the Carver College of Medicine at the University of Iowa for unrelated work. M.K. received an educational grant from Danone Nutricia to organize a conference on NEC. M.S.C. received consulting fees from Sigma Tau Pharmaceuticals and lecture fees from Mead Johnson Nutrition. The remaining authors declare no competing interests.

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The Emory University Institutional Review board evaluated the audience response questions and deemed this to not be human subjects research.

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Patel, R.M., Ferguson, J., McElroy, S.J. et al. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res 88, 10–15 (2020). https://doi.org/10.1038/s41390-020-1074-4

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