Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features

Melanie Kapapa; Janina Hahne; Alexandre Serra

doi:doi:10.11648/j.ajp.20230904.14

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Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features

Melanie Kapapa^*, Janina Hahne, Alexandre Serra

Published in American Journal of Pediatrics (Volume 9, Issue 4)

Received: 2 October 2023 Accepted: 17 October 2023 Published: 11 November 2023

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Abstract

Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.

Published in	American Journal of Pediatrics (Volume 9, Issue 4)
DOI	10.11648/j.ajp.20230904.14
Page(s)	210-216
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Neonatology, Nec, Bell Classification, Survival, Outcome

References

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[26]	Yikilmaz A, Hall NJ, Daneman A, Gerstle JT, Navarro OM, Moineddin R, et al. Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatric surgery international. 2014; 30(12): 1231-40.
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[31]	Hansen ML, Juhl SM, Fonnest G, Greisen G. Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis. Acta paediatrica (Oslo, Norway: 1992). 2017; 106(3): 399-404.

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APA Style

Kapapa, M., Hahne, J., Serra, A. (2023). Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. American Journal of Pediatrics, 9(4), 210-216. https://doi.org/10.11648/j.ajp.20230904.14

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ACS Style

Kapapa, M.; Hahne, J.; Serra, A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am. J. Pediatr. 2023, 9(4), 210-216. doi: 10.11648/j.ajp.20230904.14

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AMA Style

Kapapa M, Hahne J, Serra A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am J Pediatr. 2023;9(4):210-216. doi: 10.11648/j.ajp.20230904.14

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@article{10.11648/j.ajp.20230904.14,
  author = {Melanie Kapapa and Janina Hahne and Alexandre Serra},
  title = {Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {4},
  pages = {210-216},
  doi = {10.11648/j.ajp.20230904.14},
  url = {https://doi.org/10.11648/j.ajp.20230904.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230904.14},
  abstract = {Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.
},
 year = {2023}
}

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TY  - JOUR
T1  - Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features
AU  - Melanie Kapapa
AU  - Janina Hahne
AU  - Alexandre Serra
Y1  - 2023/11/11
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230904.14
DO  - 10.11648/j.ajp.20230904.14
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 210
EP  - 216
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230904.14
AB  - Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.

VL  - 9
IS  - 4
ER  -

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Author Information

Melanie Kapapa

Division of Pediatric Surgery, Department of Surgery, University Medical Centre Ulm, Ulm, Germany

Contact Email
Janina Hahne

Department of Pediatric and Adolescent Medicine, University Medical Centre Ulm, Ulm, Germany
Alexandre Serra

Division of Pediatric Surgery, Department of Surgery, University Medical Centre Ulm, Ulm, Germany

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APA Style

Kapapa, M., Hahne, J., Serra, A. (2023). Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. American Journal of Pediatrics, 9(4), 210-216. https://doi.org/10.11648/j.ajp.20230904.14

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ACS Style

Kapapa, M.; Hahne, J.; Serra, A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am. J. Pediatr. 2023, 9(4), 210-216. doi: 10.11648/j.ajp.20230904.14

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AMA Style

Kapapa M, Hahne J, Serra A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am J Pediatr. 2023;9(4):210-216. doi: 10.11648/j.ajp.20230904.14

Copy | Download

@article{10.11648/j.ajp.20230904.14,
  author = {Melanie Kapapa and Janina Hahne and Alexandre Serra},
  title = {Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {4},
  pages = {210-216},
  doi = {10.11648/j.ajp.20230904.14},
  url = {https://doi.org/10.11648/j.ajp.20230904.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230904.14},
  abstract = {Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.
},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features
AU  - Melanie Kapapa
AU  - Janina Hahne
AU  - Alexandre Serra
Y1  - 2023/11/11
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230904.14
DO  - 10.11648/j.ajp.20230904.14
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 210
EP  - 216
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230904.14
AB  - Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.

VL  - 9
IS  - 4
ER  -

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