Prediction of GutCheck^NECand Its Relation to Severity of Illness and Measures of Deterioration in Necrotizing Enterocolitis

Background: Necrotizing enterocolitis (NEC) risk has been shown to arise from multiple sources and risk awareness may be supported using bedside tools. Purpose: The purpose of this research was to examine the extent to which GutCheck^NECwas associated with scores for clinical deterioration, severity of illness, and clinical outcome, and further to examine how scores might improve NEC prediction. Methods: A retrospective, correlational case-control study with infant data from 3 affiliated neonatal intensive care units was conducted. Results: Of 132 infants (44 cases, 88 controls), most were 28 weeks of gestation at birth and less (74%). Median age at NEC onset was 18 days (range: 6-34 days), with two-thirds diagnosed before 21 days. At 68 hours of life, higher GutCheck^NECscores were associated with NEC requiring surgery or resulting in death (relative risk ratio [RRR] = 1.06, P =.036), associations that persisted at 24 hours prior to diagnosis (RRR = 1.05, P =.046), and at the time of diagnosis (RRR = 1.05, P =.022) but showed no associations for medical NEC. GutCheck^NECscores were significantly correlated with pediatric early warning scores (PEWS) (r > 0.30; P <.005) and SNAPPE-II scores (r > 0.44, P <.0001). Increasing numbers of clinical signs and symptoms were positively associated with GutCheck^NECand PEWS at the time of diagnosis (r = 0.19, P =.026; and r = 0.25, P =.005, respectively). Implications for Practice and Research: GutCheck^NECprovides structure to streamline assessment and communication about NEC risk. Yet, it is not intended to be diagnostic. Research is needed on how GutCheck^NECimpacts timely recognition and treatment.