{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:26:04Z","timestamp":1778664364338,"version":"3.51.4"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with Bell's Stage II\/III necrotizing enterocolitis (NEC) may have more severe presentations, higher rates of death, and more long-term complications than those with Bell's Stage I NEC, so the purpose of this article was to construct a nomogram model to distinguish Bell's stage II\/III NEC early from Bell's Stage I NEC, which is critical in the clinical management of NEC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>A total of 730 NEC newborns diagnosed from January 2015 to January 2021 were retrospectively studied. They were randomly divided into training and validation groups at the ratio of 7:3. A nomogram model for predicting NEC was developed based on all the independent risk factors by multivariate regression analysis. The model's performance was mainly evaluated through three aspects: the area under the curve (AUC) to verify discrimination, the Hosmer\u2013Lemeshow test and calibration curve to validate the consistency, and decision curve analysis (DCA) to determine the clinical effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Predictors included in the prediction model were gestational age (GA), birth weight (BW), asphyxia, septicemia, hypoglycemia, and patent ductus arteriosus (PDA). This nomogram model containing the above-mentioned six risk factors had good discrimination ability in both groups, and the AUCs were 0.853 (95% CI, 0.82\u20130.89) and 0.846 (95% CI, 0.79\u20130.90), respectively. The calibration curve and DCA confirmed that the nomogram had good consistency and clinical usefulness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This individual prediction nomogram based on GA, BW, asphyxia, septicemia, hypoglycemia, and PDA served as a useful tool to risk-stratify patients with NEC, and can help neonatologists early distinguish Bell's stage II\/III NEC early from Bell's Stage I NEC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.863719","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T05:58:18Z","timestamp":1655186298000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Development and Validation of a Nomogram for Predicting the Risk of Bell's Stage II\/III Necrotizing Enterocolitis in Neonates Compared to Bell's Stage I"],"prefix":"10.3389","volume":"10","author":[{"given":"Shuting","family":"Song","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuwei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liying","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"F182","DOI":"10.1136\/archdischild-2017-313880","article-title":"Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review","volume":"103","author":"Battersby","year":"2018","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.2174\/1573396315666181130144925","article-title":"Long-term outcome of infants with NEC","volume":"15","author":"Federici","year":"2019","journal-title":"Curr Pediatr Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"115","DOI":"10.2174\/1573396315666190312093119","article-title":"Necrotizing Enterocolitis: Long Term Complications","volume":"15","author":"Bazacliu","year":"2019","journal-title":"Curr Pediatr Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1016\/S0140-6736(06)69525-1","article-title":"Necrotising enterocolitis","volume":"368","author":"Lin","year":"2006","journal-title":"Lancet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.pedneo.2016.10.004","article-title":"Necrotizing enterocolitis in low birth weight infants in china: mortality risk factors expressed by birth weight categories","volume":"58","author":"Qian","year":"2017","journal-title":"Pediatr Neonatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0194352","article-title":"Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. a national case-control study","volume":"13","author":"Ahle","year":"2018","journal-title":"PLoS ONE."},{"key":"B8","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1159\/000489677","article-title":"Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study","volume":"114","author":"Berkhout","year":"2018","journal-title":"Neonatology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1007\/s12519-015-0063-x","article-title":"Predictive scores for mortality in full-term infants with necrotizing enterocolitis: experience of a Tertiary Hospital in Southwest China","volume":"12","author":"Zhang","year":"2016","journal-title":"World J Pediatr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1016\/j.amjsurg.2021.04.025","article-title":"Abdominal ultrasound findings contribute to a multivariable predictive risk score for surgical necrotizing enterocolitis: a pilot study","volume":"222","author":"Lazow","year":"2021","journal-title":"Am J Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1111\/j.1464-410X.2006.06694.x","article-title":"A critical appraisal of logistic regression-based nomograms, artificial neural networks, classification and regression-tree models, look-up tables and risk-group stratification models for prostate cancer","volume":"99","author":"Chun","year":"2007","journal-title":"BJU Int."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fped.2021.648828","article-title":"Development and validation of a nomogram for predicting bronchopulmonary dysplasia in very-low-birth-weight infants","volume":"9","author":"Zhang","year":"2021","journal-title":"Front Pediatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. therapeutic decisions based upon clinical staging","volume":"187","author":"Bell","year":"1978","journal-title":"Ann surg."},{"key":"B14","volume-title":"Williams Obstetrics","author":"Cunningham","year":"2014"},{"key":"B15","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1471-2431-13-59","article-title":"A systematic review and meta-analysis to revise the fenton growth chart for preterm infants","author":"Fenton","year":"2013","journal-title":"BMC Pediatr."},{"key":"B16","unstructured":"Hypoglycaemia-newborn2019"},{"key":"B17","doi-asserted-by":"publisher","first-page":"176","DOI":"10.3760\/cma.j.issn.2095-428X.2018.03.005","article-title":"Neonatal anemia and transfusion","volume":"33","author":"Jingwen","year":"2018","journal-title":"Zhonghua Er Ke Za Zhi."},{"key":"B18","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1097\/AOG.0b013e31822f1713","article-title":"Application of criteria developed by the task force on Neonatal Encephalopathy and Cerebral Palsy to Acutely Asphyxiated Neonates","volume":"118","author":"Phelan","year":"2011","journal-title":"Obstet Gynecol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3389\/fped.2017.00147","article-title":"Echocardiographic evaluation of patent ductus arteriosus in preterm infants","volume":"5","author":"Arlettaz","year":"2017","journal-title":"Front Pediatr."},{"key":"B20","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1542\/peds.114.1.297","article-title":"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation","volume":"114","year":"2004"},{"key":"B21","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal Outcomes of Extremely Preterm Infants from the Nichd Neonatal Research Network","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics."},{"key":"B22","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.jfma.2013.03.010","article-title":"Prevention of necrotizing enterocolitis in preterm very low birth weight infants: is it feasible?","volume":"113","author":"Lin","year":"2014","journal-title":"J Formos Med Assoc."},{"key":"B23","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1097\/01.shk.0000192126.33823.87","article-title":"Cytokines in necrotizing enterocolitis","volume":"25","author":"Markel","year":"2006","journal-title":"Shock."},{"key":"B24","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.pedneo.2016.04.002","article-title":"Risk factors for necrotizing enterocolitis in neonates: a retrospective case-control study","volume":"58","author":"Lu","year":"2017","journal-title":"Pediatr Neonatol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s12098-013-1311-5","article-title":"Risk Factors and Outcome in Neonatal Necrotising Enterocolitis","volume":"81","author":"Gane","year":"2014","journal-title":"Indian J Pediatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2058738420963818","DOI":"10.1177\/2058738420963818","article-title":"Risk factors of necrotizing enterocolitis in neonates with sepsis: a retrospective case-control study","volume":"34","author":"Wang","year":"2020","journal-title":"Int J Immunopathol Pharmacol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1001\/jamapediatrics.2016.2132","article-title":"Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis","volume":"170","author":"Ting","year":"2016","journal-title":"JAMA Pediatr."},{"key":"B28","first-page":"252","volume":"57","year":"2019","journal-title":"Zhoughua Er Ke Za Zhi."},{"key":"B29","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1242\/dmm.044388","article-title":"Precision-based modeling approaches for necrotizing enterocolitis","author":"Kovler","year":"2020","journal-title":"Dis Model Mech."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1016\/j.jpedsurg.2011.06.032","article-title":"Total oxidant status and oxidative stress are increased in infants with necrotizing enterocolitis","volume":"46","author":"Aydemir","year":"2011","journal-title":"J Pediatr Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"CD006181","DOI":"10.1002\/14651858.CD006181.pub2","article-title":"Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants","volume":"2008","author":"Mosalli","year":"2010","journal-title":"Cochrane Database Syst Rev."},{"key":"B32","doi-asserted-by":"publisher","first-page":"CD003481","DOI":"10.1002\/14651858.CD003481.pub7","article-title":"Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants","volume":"9","author":"Ohlsson","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e237","DOI":"10.3928\/00904481-20151012-07","article-title":"Necrotizing enterocolitis in the full-term infant","volume":"44","author":"Chu","year":"2015","journal-title":"Pediatr Ann."},{"key":"B34","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1159\/000244428","article-title":"Necrotizing enterocolitis in full-term or near-term infants: risk factors","volume":"71","author":"Martinez-Tallo","year":"1997","journal-title":"Biol Neonate."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e0254810","DOI":"10.1371\/journal.pone.0254810","article-title":"The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates","volume":"16","author":"Song","year":"2021","journal-title":"PLoS ONE."},{"key":"B36","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1586\/ers.10.22","article-title":"Transfusion therapy and acute lung injury","volume":"4","author":"Sokolovic","year":"2010","journal-title":"Expert Rev Respir Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1053\/j.semperi.2008.01.003","article-title":"The neonatal intestinal vasculature: contributing factors to necrotizing enterocolitis","volume":"32","author":"Nankervis","year":"2008","journal-title":"Semin Perinatol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1515\/jpm-2017-0162","article-title":"Transfusion-associated necrotizing enterocolitis in preterm infants: an updated meta-analysis of observational data","volume":"46","author":"Garg","year":"2018","journal-title":"J Perinat Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3109\/14767058.2015.1016422","article-title":"Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions","volume":"29","author":"Sood","year":"2016","journal-title":"J Matern Fetal Neonatal Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"633088","DOI":"10.3389\/fped.2021.633088","article-title":"Racial disparities in necrotizing enterocolitis","volume":"9","author":"Cuna","year":"2021","journal-title":"Front Pediatr."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.863719\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T05:58:23Z","timestamp":1655186303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.863719\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,14]]},"references-count":40,"alternative-id":["10.3389\/fped.2022.863719"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.863719","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,14]]},"article-number":"863719"}}