Defining Necrotizing Enterocolitis: Current Difficulties and Future Opportunities

Patel, R.M., Ferguson, J., McElroy, S.J. et al. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res 88, 10–15 (2020). https://doi.org/10.1038/s41390-020-1074-4

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in hospitalized infants. First classified through Bell staging in 1978, a number of additional definitions of NEC have been proposed in the subsequent decades. In this review, we summarize eight current definitions of NEC, and explore similarities and differences in clinical signs and radiographic features included within these definitions, as well as their limitations. We highlight the importance of a global consensus on defining NEC to improve NEC research and outcomes, incorporating input from participants at an international NEC conference. We also highlight the important role of patient-families in helping to redefine NEC.

Defining a disease or condition has important implications. Meeting a set of criteria for a disease or condition can influence how a patient or family perceives their condition, what kind of prognostic information they receive, and how they are monitored, evaluated, and treated. A disease definition may influence the feasibility and generalizability of studies, how outcomes are compared across centers and countries, how biomarkers or other tools are developed and used for diagnosis or prognosis, and how treatment is approached and research funded. In this review, we summarize how the definition of NEC has evolved over time, compare NEC definitions, and highlight the urgent need to develop an accurate, reliable, and reproducible definition of NEC that can garner global consensus.

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