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The ConNECtion Between Abdominal Signs and Necrotizing Enterocolitis in Infants 501 to 1500 g

Gephart, Sheila M. PhD, RN; Fleiner, Michelle DNP, RNC-NIC, CCNS; Kijewski, Amy FNP-BC, DNP

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000345
Original Research

Background: Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important.

Purpose: The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.

Methods: A 3-site, descriptive correlational case-control design with retrospective data collection was used matching each NEC case to 2 controls (N = 132).

Results: NEC cases were exposed to less human milk and fed later. Among them, 61% (n = 27) had at least 1 abdominal sign 36 hours before diagnosis, with fewer numbers having 2 (18%; n = 8) or 3 (5%; n = 2). At 36 hours before NEC, abdominal distension, duskiness, higher gastric residual, and greater count of abdominal signs were associated with severe NEC. No medical NEC cases had abdominal signs 36 or 24 hours before diagnosis. Highest severity of NEC was related to more abdominal signs at the times leading up to and at diagnosis of NEC. Gastric residuals were largely unrelated to NEC except for the most severe NEC at 36 hours before diagnosis.

Implications for Practice: Communicating a count of abdominal signs may support earlier recognition and treatment of NEC.

Implications for Research: More research is needed to explore timing for clinical worsening of status (eg, surgical and NEC leading to death) and to study effective clinical approaches targeting early recognition to support timely action.

The University of Arizona College of Nursing, Tucson, Arizona (Drs Gephart and Kijewski); and Banner Health, Cardon Children's Medical Center, Mesa, Arizona (Dr Fleiner).

Correspondence: Sheila M. Gephart, PhD, RN, Assistant Professor, The University of Arizona College of Nursing, PO Box 210203, Tucson, AZ 85721 (

Work took place at Banner Health in Arizona and analysis was completed at the University of Arizona.

This project was funded by the Lawrence B. Emmons Foundation from the University of Arizona and supported by Banner Health. Dr Gephart acknowledges research support from the Robert Wood Johnson Foundation Nurse Faculty Scholars Program and the Agency for Healthcare Research and Quality (K08HS022908). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or Robert Wood Johnson Foundation.

The authors declare no conflicts of interest.

© 2017 by The National Association of Neonatal Nurses