Dr Minesh Khashu

Dr Phillip Gordon

Ravi Patel, MD

Prof David Hackam

Dr Caron Parsons

Prof Boris Kramer

Meeting of the Special Interest Group in Necrotizing Enterocolitis, London 2018

The 6th international conference was held in London on the 29th and 30th of October. This year day one focused on NEC definitions and datasets while day two considered the family experience, long-term concerns for babies post-NEC and recent advances in diagnosis and quality improvement with regard to NEC.

During some presentations, delegates were invited to offer their opinions and ideas using Slido, an audience interaction tool. The summary of the discussions on NEC definitions and audience feedback with regard to definition(s) of NEC that incorporates subsets will be shared later in the year through a separate publication.

You may view the conference programme here, and the following summaries and presentations appear by kind permission of the speakers. Some slides and data may have been removed at their request.

Please contact us if you have any specific feedback or suggestion with regard to future SIGNEC conferences and related events.

 

Day One – NEC definitions, subsets and data sets

NEC: the defining moment!

Prof Minesh Khashu MBBS, MD, FRCPCH, FRSA

Consultant in Neonatal Medicine

Poole Hospital NHS FT

Contact and research information

Follow @mkrettiwt

SIGNEC founder Professor Minesh Khashu explained to the audience why one of the main obstacles to improving outcomes is the lack of universal definitions for NEC and NEC subgroups. This has led to ‘contaminated datasets’ that restrict our ability to extract useful information and gain insight. It is crucial for the global neonatal community to come to a consensus regarding NEC definitions.

Professor Khashu shared his thoughts on artificial intelligence technologies in health care and the potential use of predictive monitoring and computer-aided diagnosis and treatment for NEC. This involves analysing physiological data to identify infants at high risk of NEC and/or potentially life-threatening scenarios (eg intestinal perforation). The early detection of abnormal physiological patterns has the potential to predict morbidity or mortality so that appropriate treatment can be given at an early stage and thus improve outcomes.

 

NEC: the defining moment!

What is wrong with NEC data? A subset approach to NEC.

Phillip V. Gordon MD PhD

Professor of Pediatrics

Sacred Heart Hospital, Pensacola, Florida

In his talk, Professor Phillip Gordon reiterated why we must redefine NEC. NEC data consist of many entities, some of which are not NEC. These include spontaneous intestinal perforations (SIP), food protein-induced enterocolitis syndrome, and NEC that occurs from pre-existing conditions associated with term infancy or congenital anomalies. Most of these are fundamentally different versions of disease when compared to preterm NEC. Professor Gordon stressed that future definitions of NEC must seek to exclude and tabulate these confounding factors.

One fundamental concern is that preterm NEC consists of several subgroups, although these are increasingly becoming better defined. Professor Gordon summarised the subgroup entities and gave references in the literature for further review. He discussed the concepts regarding NEC subgrouping and how we might move forward with this. He affirmed Professor Khashu’s assertion that the critical next step is to correctly define NEC and clean-up our datasets. Professor Gordon went on to further discuss artificial intelligence-based medical diagnostics and how these might, or might not, work for NEC.

 

What is wrong with NEC data?

Current NEC definitions and considerations in redefining NEC

Ravi Mangal Patel, MD, MSc

Associate Professor of Pediatrics

Division of Neonatology

Emory University School of Medicine, Georgia

Contact and research information Follow @ravimpatelmd
In 1978, Dr. Martin Bell and colleagues proposed the first clinical staging for necrotizing enterocolitis (NEC). Forty years later, this remains the most common criteria applied to the diagnosis of NEC. Potential limitations of Bell staging include: contamination from spontaneous intestinal perforation, high incidence of stage I, uncertainty of the presence of pneumatosis, lack of accounting for baseline risk and the case-definition not being explicit. Since the initial report of Bell staging, multiple other approaches to diagnose or stage NEC have been proposed:
Definition or staging criteria for NEC Source
Bell stagingBell et al. Ann Surg. 1978.
Modified Bell stagingWalsh and Kliegman. Pediatr Clinics N Am. 1984.
Stanford NEC scoreJi et al. PLOS One. 2014
Severe NECBattersby et al. Lancet Gastroenterol Hepatol. 2016
Gestational age-specific case definitionBattersby et al. JAMA Pediatr. 2017
Two of 3 ruleGordon et al. Sem Perinatol. 2017
CDC definitionhttps://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf

VON definitionhttps://vtoxford.zendesk.com/hc/en-us/articles/360013115393-2019-Manual-of-Operations-Part-2-Release-23-1-PDF-

During this session, the following 7 considerations were proposed to consider in redefining NEC:

 

  1. Address possible contamination by spontaneous intestinal perforation.
  2. Avoid inclusion of Bell stage I (or equivalent cases).
  3. Incorporate risk-stratification into definitions (e.g. gestational age).
  4. Assess predictive ability of measures (e.g. abdominal tenderness) to guide inclusion.
  5. Compare performance of case-definitions in classifying important outcomes among infants with NEC.
  6. Describe how uncertainty addressed (e.g. findings of questionable or possible pneumatosis).
  7. Incorporate tools to estimate pre-test probability of NEC before diagnostic testing.

Current NEC definitions and considerations in redefining NEC

Supplement in Infant magazine

All these summaries are available to view and save as a PDF

Programmes and reports from previous conferences

SIGNEC conferences have been supported by educational grants from Nutricia Early Life Nutrition.

Conference photography by David Betteridge