Methods of identifying surgical necrotizing enterocolitis – a systematic review and meta-analysis

Abstract

Background: current data suggests potential benefit of earlier surgery for necrotising enterocolitis (NEC) however this requires accurate prognostication early in the disease course. This study aims to identify and determine the effectiveness of previously reported methods or tests for the identification of surgical NEC.

Methods: systematic review and meta-analysis with registration on PROSPERO including articles describing a method of identifying surgical NEC. Outcomes of interest were effectiveness and repeatability of index test.

Results: of the 190 full-text articles screened, 90 studies were included which contained 114 methods of identifying surgical NEC in 9546 infants. Of these methods, 44 were a scoring system, 37 a single biomarker, 24 an imaging method and 9 an invasive method. Sensitivity and specificity ranged from 12.8-100% and 13-100%, respectively. Some methods (9.6%) provided insufficient methods for repeatability within clinical practice or research. Meta-analyses were possible for only 2 methods, the metabolic derangement 7 score and abdominal ultrasound.

Conclusions: a range of methods for identifying surgical NEC have been identified with varying overall performance and uncertainties about reproducibility and superiority of any method. External validation in large multicentre datasets should allow direct comparison of accuracy and prospective study should evaluate impact on clinical outcomes.

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Identifiers

ORCID for George S. Bethell: orcid.org/0000-0002-1302-0735

ORCID for Nigel J. Hall: orcid.org/0000-0001-8570-9374

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