Challenges in diagnosing necrotizing enterocolitis


One of the many challenges with necrotizing enterocolitis (NEC) remains our inability to make an accurate diagnosis of NEC. The lack of a unifying cause and multiple variations in presentations lead to great uncertainty with NEC. Separating out the needs of the researcher wanting to define NEC from the clinician and patient family’s perspectives who want an accurate diagnosis for NEC is important. The need to augment and/or replace the outdated modified Bell staging criteria is crucial to improving NEC management. Emerging literature suggests that genetic susceptibility and stool microbiota signatures may help identify preterm infants at increased risk of the disease. Ongoing studies using single or multi-omic approaches may help to characterize biomarkers that will aid in the prediction or early diagnosis of NEC, as well as differentiate other causes of severe bowel injury. Bowel ultrasound shows promise in improving our diagnostic accuracy for NEC but has been slow in adoption. Patient family perspectives are key in accelerating our efforts to integrate newer diagnostic methods into practice.

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Fig. 1: NEC potpourri.


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V.S. is supported by 1R01DK117296-A1 from the National Institutes of Health and a Katharine Berry Richardson Award. 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.

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All authors made substantial contributions to conception of the article, drafting the article, critical revisions, and approval of the final version to be published.

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Correspondence to Jae H. Kim.

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Competing interests

J.H.K. received grant support from Mallinckrodt and Fresenius-Kabi; received consultant or advisor fees from Evolve Bioscience, Medela, Alcresta, and Ferring; received lecture fees from Mead Johnson Nutrition and Abbott Nutrition; owns shares in Nicolette and Astarte Medical; served as expert witness; and holds a patent for a newborn heart rate device. None of these entities or funding bodies had any role in this manuscript. J.C. is the founder and Director of The NEC Society, sponsor of the supplement.

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Kim, J.H., Sampath, V. & Canvasser, J. Challenges in diagnosing necrotizing enterocolitis. Pediatr Res 88, 16–20 (2020).

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