48-hour nomogram stratifies NEC risk among neonates with gastrointestinal symptoms

A nomogram combining postnatal laboratory indicators with pre-symptom clinical-course variables showed good internal performance for distinguishing stage II or III necrotizing enterocolitis from milder or nonprogressive gastrointestinal conditions in neonates admitted with suspected NEC or feeding-intolerance manifestations. In the single-center retrospective study, the model had an apparent area under the receiver operating characteristic curve of 0.839 (95% CI, 0.785–0.893) and a bootstrap optimism-corrected AUC of 0.826.

The researchers analyzed 248 neonates admitted to the neonatal intensive care unit of Southwest Hospital between January 2018 and January 2024. Seventy-seven children had NEC, defined as Modified Bell stage II or III, and 171 controls had stage I disease or other gastrointestinal manifestations, including vomiting, regurgitation or abdominal distension, without progression to NEC. The sample included 14.1% born before 32 weeks of gestation and 13.3% with a birth weight below 1,500 g.

Candidate predictors comprised perinatal characteristics, feeding-related variables, pre-symptom clinical-course information and routine laboratory indicators measured within 48 hours after birth. Multivariable logistic regression was used to construct the nomogram, which ultimately included the 5-minute Apgar score, parenteral nutrition, feeding-advancement rate, neutrophil percentage and procalcitonin. At an optimal cutoff of 0.353, the model had sensitivity of 71.4% and specificity of 86.0%.

Model assessment included discrimination, calibration, decision-curve analysis and bootstrap internal validation. Calibration analysis indicated acceptable agreement between predicted and observed risks, while decision-curve analysis suggested potential clinical usefulness. These findings support the model’s internal performance rather than establishing clinical benefit. The authors noted that external validation, particularly in very-preterm and very-low-birth-weight populations, is required before clinical implementation. The retrospective, single-center design and the selected population of neonates with suspected NEC or related gastrointestinal manifestations limit generalizability and mean that the model was not evaluated as a universal prediction tool for all newborns.

Subject of Research: Internal validation of an early necrotizing enterocolitis risk-stratification nomogram in neonates with gastrointestinal manifestations

Article Title: Early risk stratification of necrotizing enterocolitis using 48-h laboratory indicators and pre-symptom clinical-course variables: a single-center retrospective study

Article References: Lang, Y., Hu, Y., Yan, L., & Shen, L. (2026). Early risk stratification of necrotizing enterocolitis using 48-h laboratory indicators and pre-symptom clinical-course variables: a single-center retrospective study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07665-x

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07665-x

Keywords: necrotizing enterocolitis, neonatal intensive care, risk stratification, nomogram, laboratory indicators, feeding intolerance, premature infants, internal validation, Early, risk, stratification, necrotizing