102 - Neonatal Sequential Organ Failure Assessment (nSOFA) Differentiates Surgical Necrotizing Enterocolitis, Medical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

Poster Number: 102
Publication Number: 102.237

Marshall W. Wallace, Vanderbilt University School of Medicine, Nashville, TN, United States; Jamie Robinson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Mhd Wael Alrifai, Vanderbilt University School of Medicine, Nashville, TN, United States; Joern-Hendrik Weitkamp, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Stephanie N. Moore-Lotridge, VUMC, Nashville, TN, United States; Jonathan Schoenecker, Vanderbilt University Medical Center, Nashville, TN, United States; Shilin Zhao, Vanderbilt University School of Medicine, Nashville, TN, United States; Jeffrey S.. Upperman, Vanderbilt University Medical Center, Nashville, TN, United States; Irving J.. Zamora, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Martin Blakely, Vanderbilt University School of Medicine, Nashville, TN, United States

Background:
Distinction of surgical necrotizing enterocolitis (NEC) from medical NEC and spontaneous intestinal perforation (SIP) is important clinically as the optimal surgical treatment likely differs between the three diagnoses. This diagnostic distinction is known to be difficult and novel methods of improving the diagnostic accuracy are needed. The nSOFA score, which incorporates metrics of immunocoagulopathy and organ dysfunction, effectively predicts mortality in infants with sepsis and NEC. Since surgical NEC, medical NEC and SIP are hypothesized to have variable levels of immunocoagulopathy, organ dysfunction, and acuity, nSOFA scores may be a useful adjunct in the diagnostic differentiation of these conditions.


Objective: We tested the hypothesis that in preterm neonates, nSOFA scores can be utilized to effectively distinguish cases of surgical NEC, medical NEC and SIP.

Design/Methods: A retrospective, single-center study of preterm neonates admitted between 2019 and 2022. All nSOFA scores for 72 hours following surgical consult were averaged then analyzed between patients with medical NEC, surgical NEC, and SIP. Data were curated from institutional research derivative database and EMR, “final diagnosis” was determined by full review of the infant’s hospital course by a pediatric surgeon.  Welch Two Sample t-Tests were used to compare nSOFA scores between groups.

Results: Of the 80 infants who met inclusion criteria, 60 (75%) were diagnosed with NEC, and 20 (25%) had SIP. Overall mortality was 20% (n=16). Of the NEC patients, 44 (73%) had medical NEC and 16 (27%) had surgical NEC. Mean nSOFA scores at 72 hours post-surgical consultation were significantly higher in patients with surgical NEC (5.67) than those with medical NEC (1.52, p< 0.01) or SIP (2.15, p< 0.01). Mean nSOFA scores were higher in patients with SIP (2.15) than in medical NEC (1.52, p< 0.01). Mortality rates were:  75% (12/16) in surgical NEC, 7% (3/44) with medical NEC, and 5% (1/20) with SIP.

Conclusion(s):
In this single institution case series, mean nSOFA scores from 72 hours after surgical consult for evaluation of SIP or NEC were found to be significantly different between neonates with surgical NEC, medical NEC, or SIP. This novel finding suggests that patients with surgical NEC have greater immunocoagulopathy and organ dysfunction than those with medical NEC or SIP.  These differences indicate that readily-accessible nSOFA scores may be a useful adjunct in the challenging process of distinguishing surgical NEC, medical NEC and SIP, and should be validated prospectively.