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Making an accurate distinction between necrotising enterocolitis (NEC) and focal intestinal perforation (FIP) in a preterm infant presenting with obvious abdominal pathology has challenged neonatologists and neonatal surgeons for some time. With similarities between the epidemiology, presenting symptoms, clinical signs, radiology, surgical findings, histopathology and even postmortem findings, it is unsurprising that making an accurate distinction between these disease entities is fraught with difficulty. Indeed, according to some published definitions, there is significant overlap and using some of these may result in inability to differentiate at all.1 2 Yet, there are reasons why making this distinction is important in our quest to improve both understanding and outcomes.
The recent report by Berrington and Embleton illustrates some of the difficulties nicely.3 They reviewed a large series of preterm infants born less than 32 weeks’ gestation treated over a 10-year period in a tertiary neonatal unit in Newcastle, UK. Through detailed clinical review by two senior clinicians, they assigned each infant presenting with abdominal pathology to a final diagnosis of either NEC or FIP. Although we are not told precisely how a final diagnosis was arrived at, they used a host of clinical, laboratory, radiological and surgical information combined with their extensive clinical experience. The review of all these data must have been time-consuming and challenging. Through this work, they note that there were only a very few features that were statistically different between infants with NEC or FIP. They also evaluated a number of previously reported tools for making this distinction and found them inaccurate. For example, over 85% of infants with FIP fulfilled the criteria for Bell’s stage 2 NEC or the Centre for Disease Classification NEC criteria. Using the …
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.