Introducing a new scoring system of abdominal function for early diagnosis of necrotizing enterocolitis in preterm infants

Abstract

Degree Project Thesis, Programme in Medicine. TITLE:Introducing a new scoring system of abdominal function for early diagnosis of necrotizing enterocolitis in preterm infants. Abstract Title: Introducing a new scoring system of abdominal function for early diagnosis of necrotizing enterocolitis in preterm infants Author, year: Evelina Lilja, 2014 Supervisor: Anders Elfvin, MD PhD Institution, City, Country: Division of Neonatology, Department of pediatrics, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden. Background: Necrotizing enterocolitis (NEC) is an inflammatory disease of the bowel primarily affecting premature infants. Early stages of NEC have been linked to feeding intolerance and affected abdominal status. High morbidity and mortality indicate the importance of early diagnosis. Objective: To evaluate the Gothenburg Abdominal Scoring system (GAS) to determine if GAS can be used for early diagnosis of Necrotizing enterocolitis in preterm infants. Methods: A retrospective study of 83 preterm infants born before gestational week 28+0 and treated at the NICU at the Queen Silvia Children’s Hospital in Gothenburg, Sweden. The NEC group (n=39) was diagnosed according to modified Bell’s staging criteria ≥ 2A, and the controls (n=44) were preterm infants not diagnosed with NEC. GAS score is calculated based on feeding volume, change of feeding volume since previous day, gastric residuals and frequency of stools. Data was recorded from the day of NEC diagnosis and 6 days prior. Average age at NEC diagnosis was 13 days; data from the controls were recorded from day 13 of life and 6 days prior. The GAS system would score each parameter resulting in a score from 0-8 per day where a higher score would imply a tendency towards gastrointestinal distress. Results: Average stools per day during the studied period were 1,8 ± 0,5 in the NEC group and 3,5 ± 0,4 in the control group. Days to passing of first stool was 4 ± 2,3 days in the NEC group and 2,8 ±1,8 days in the control group. Mean total gastric residual volume in the NEC group was 4,3 ± 1,3 mL and 5,8 ± 0,6 mL in the control group. The NEC group had a higher GAS score in total. Conclusions: NEC patients born before gestational week 28+0 have significantly delayed passage of meconium and significantly lower stool frequency during the days leading up to NEC diagnosis. An upward trend in the GAS system could be seen in the NEC group during these days. This was significant for the studied group as a whole but the relevance for the individual infant remains unclear. Keywords: Premature, predictors, NEC, gastric residuals, feed intolerance, stool frequency