Utilidade da aplicação de um escore de risco para a predição de enterocolite necrosante no recém-nascido
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Data
2022-08-03
Autores
Hachem, Andréa Souza
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Universidade Estadual Paulista (Unesp)
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Introdução. A enterocolite necrosante (ECN) é uma doença grave, cujo diagnóstico preciso e precoce pode influenciar no prognóstico. A utilização de escores de probabilidade pode ser útil para identificação dos casos. Objetivos. Comparar os recém-nascidos com hipótese de ECN em relação às características clínicas, laboratoriais e radiológicas e avaliar a utilidade de um escore de probabilidade de risco para ECN na predição do diagnóstico em recém-nascidos com hipótese clínica da doença. Métodos. Coorte retrospectiva com inclusão de todos os recém-nascidos com suspeita de ECN, entre junho/2012 e julho/2020, subdivididos em dois subgrupos: ECN confirmada e ECN não confirmada e comparados em relação às variáveis maternas, gestacionais e características clínicas, laboratoriais e radiológicas, no momento da hipótese diagnóstica. O escore foi calculado de acordo com o escore de Battersby, ou seja, divididos em 3 faixas de idade gestacional (< 30, 30 a < 37 e ≥ 37 semanas) e segundo os achados de alteração de cor abdominal, dor à palpação, resíduo bilioso associado à distensão abdominal, sangue nas fezes, presença de pneumoperitônio, alça fixa, ar no sistema porta-hepático e pneumatose intestinal. Os subgrupos foram comparados em relação aos valores de sensibilidade (S), especificidade (E), acurácia, valor preditivo positivo (VPP) e valor preditivo negativo (VPN). Foram também construídas as curvas ROC (Receiver Operator Curve) para determinação de ponto de corte na amostra estudada. Resultados. Foram estudados 103 recém-nascidos, sendo 47 casos confirmados e 56 não confirmados. Não houve diferença entre os grupos em relação às variáveis maternas e gestacionais e características gerais dos recém-nascidos. Pacientes do grupo ECN confirmada iniciaram a dieta enteral e atingiram a dieta plena mais cedo, com menor uso de leite materno exclusivo e introdução mais frequente de fórmula até 72 horas antes do aparecimento dos sinais e sintomas; também nesse grupo observou-se maior gravidade no momento da suspeita diagnóstica, caracterizada por maior frequência de manifestações sistêmicas e pneumatose intestinal na radiografia. O escore de Battersby foi capaz de predizer o diagnóstico final em 74% dos casos (66/89), com sensibilidade de 81%, especificidade de 69%, VPP de 63% e VPN de 83%. O ponto de corte encontrado na amostra foi de 3 (S=79; E=84%). Conclusão: Neste estudo, recém-nascidos que receberam menos leite materno e que apresentaram quadro clínico inicial mais grave tiveram o diagnóstico confirmado de ECN mais frequentemente. A utilização do escore de Battersby foi mais útil na predição de casos não confirmados.
Introduction. Necrotizing enterocolitis (NEC) is a serious disease, whose accurate and early diagnosis can influence the prognosis. The use of probability scores can be useful for case identification. Objective. To compare newborns with a hypothesis of NEC in terms of clinical, laboratory and radiological characteristics and to assess the usefulness of a risk probability score for NEC in predicting the diagnosis in newborns with a clinical hypothesis of the disease. Methods. Retrospective cohort study including all newborns with suspected NEC, between June/2012 and July/2020, subdivided into two subgroups: confirmed NEC and unconfirmed NEC and compared in terms of maternal and gestational variables, and also clinical, laboratory and radiological findings at the moment of the diagnostic hypothesis. The score was calculated according to the Battersby score, that is, divided into 3 ranges of gestational age (< 30, 30 to < 37 and ≥ 37 weeks) and according to the findings of abdominal discoloration, abdominal tenderness, increased and/or bilious aspirates associated with abdominal distention, blood in the stool, presence of pneumoperitoneum, fixed loop, portal venous gas system and intestinal pneumatosis. Subgroups were compared in terms of sensitivity (S), specificity (E), accuracy, positive predictive value (PPV) and negative predictive value (NPV). The Receiver Operator Curves (ROC) were also constructed to determine the cut-off point in the studied sample. Results. A total of 103 newborns were studied, with 47 confirmed cases and 56 unconfirmed. There was no difference between the groups regarding maternal and gestational variables and general characteristics of the newborns. Patients in the confirmed NEC group started the enteral diet and reached the full diet earlier, with less use of exclusive breast milk and more frequent introduction of formula up to 72 hours before the appearance of signs and symptoms; also in this group, greater severity was observed at the time of diagnostic suspicion, characterized by a greater frequency of systemic manifestations and pneumatosis intestinalis on radiography. The Battersby score was able to predict the final diagnosis in 74% of cases (66/89), with sensitivity of 81%, specificity of 69%, PPV of 63% and NPV of 83%. The cut-off point found in the sample was 3 (S=79; E=84%). Conclusion. In this study, newborns who received less breast milk and who had a more severe initial clinical condition were more frequently confirmed with the diagnosis of NEC. The use of the Battersby score was more useful in predicting unconfirmed cases.
Introduction. Necrotizing enterocolitis (NEC) is a serious disease, whose accurate and early diagnosis can influence the prognosis. The use of probability scores can be useful for case identification. Objective. To compare newborns with a hypothesis of NEC in terms of clinical, laboratory and radiological characteristics and to assess the usefulness of a risk probability score for NEC in predicting the diagnosis in newborns with a clinical hypothesis of the disease. Methods. Retrospective cohort study including all newborns with suspected NEC, between June/2012 and July/2020, subdivided into two subgroups: confirmed NEC and unconfirmed NEC and compared in terms of maternal and gestational variables, and also clinical, laboratory and radiological findings at the moment of the diagnostic hypothesis. The score was calculated according to the Battersby score, that is, divided into 3 ranges of gestational age (< 30, 30 to < 37 and ≥ 37 weeks) and according to the findings of abdominal discoloration, abdominal tenderness, increased and/or bilious aspirates associated with abdominal distention, blood in the stool, presence of pneumoperitoneum, fixed loop, portal venous gas system and intestinal pneumatosis. Subgroups were compared in terms of sensitivity (S), specificity (E), accuracy, positive predictive value (PPV) and negative predictive value (NPV). The Receiver Operator Curves (ROC) were also constructed to determine the cut-off point in the studied sample. Results. A total of 103 newborns were studied, with 47 confirmed cases and 56 unconfirmed. There was no difference between the groups regarding maternal and gestational variables and general characteristics of the newborns. Patients in the confirmed NEC group started the enteral diet and reached the full diet earlier, with less use of exclusive breast milk and more frequent introduction of formula up to 72 hours before the appearance of signs and symptoms; also in this group, greater severity was observed at the time of diagnostic suspicion, characterized by a greater frequency of systemic manifestations and pneumatosis intestinalis on radiography. The Battersby score was able to predict the final diagnosis in 74% of cases (66/89), with sensitivity of 81%, specificity of 69%, PPV of 63% and NPV of 83%. The cut-off point found in the sample was 3 (S=79; E=84%). Conclusion. In this study, newborns who received less breast milk and who had a more severe initial clinical condition were more frequently confirmed with the diagnosis of NEC. The use of the Battersby score was more useful in predicting unconfirmed cases.
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Palavras-chave
Enterocolite necrosante, Recém-nascido, Diagnóstico, Necrotizing enterocolitis, Newborn, Diagnosis