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Table 3 Modified Bell staging criteria for neonatal necrotising enterocolitis

From: Application effect of extensively hydrolyzed milk protein formula and follow-up in preterm children with a gestational age of less than 34 weeks: study protocol for a randomized controlled trial

Staging

Systemic symptoms

Gastrointestinal symptoms

Radiological signs

Treatment

IA Suspected NEC

Temperature instability, apnoea, bradycardia, lethargy

Gastric retention, mild abdominal distension, fecal occult blood positive

Normal or intestinal dilation, mild ileus

Absolute fasting, gastric decompression, antibiotic therapy for 3 days, waiting for pathogen culture results

IB Suspected NEC

Same as IA

Bright-red blood from rectum

Same as IA

Same as IA

IIA proven NEC (mildly ill)

Same as IA

Same as IA or IB, plus absent bowel sounds, and (or) abdominal tenderness,

Intestinal dilation, ileus, pneumatosis intestinalis

Same as IA, absolute fasting. If 24–48 h culture shows no abnormality, use antibiotics for 7– 10 days

IIB proven NEC (moderately ill)

Same as IIA, plus mild metabolic acidosis and mild thrombocytopenia

Same as IIA,plus absent bowel sounds, definite abdominal tenderness, and (or) abdominal cellulitis or right lower quadrant mass

Same as IIA, plus portal vein gas, and (or) ascites

Same as IIA, absolute fasting. Supplement blood volume, treat acidosis, and use antibiotics for 14 days

IIIA Advanced NEC (severely ill, bower intact)

Same as IIB, plus hypotension, bradycardia, severe apnea, mixed acidosis, DIC, neutropenia, anuria

Same as IIB, plus signs of generalized peritonitis, abdominal distension or marked tenderness, and redness and swelling of abdominal wall

Same as IIB, ascites

Transfer to the Surgical Department of Children’s Hospital for observation

IIIB Advanced NEC (severely ill, bowel perforated)

Same as IIIA, plus suddenly aggravation of conditions

Same as IIIA, plus sudden aggravation of abdominal distension

Same as IIB, pneumoperitoneum

Transfer to the Surgical Department of Children’s Hospital for surgery

  1. NEC necrotising enterocolitis, DIC disseminated intravascular coagulation