TY - JOUR
T1 - Definitions of neonatal Necrotizing Enterocolitis (NEC) in randomised controlled trials
T2 - a systematic review
AU - Ballantine, Robert Seán
AU - Campbell, Ellen
AU - Croitoru, Ovidiu
AU - Jackson, Emma
AU - Lyne, Eric John
AU - McGoldrick, Ciara
AU - Murphy, Sally Mary
AU - Oganezova, Karina
AU - Shukla, Tavishi
AU - Yogesan, Sujjanv S
AU - Trayer, James
AU - Stewart, Philip
AU - Carroll, Stephen
AU - Branagan, Aoife
AU - Roche, Edna
AU - Tabassum, Saira
AU - Abrahamsson, Thomas
AU - Embleton, Nicholas
AU - Berrington, Janet
AU - de Pipaon Miguel, Saenz
AU - Klerk, Daphne H
AU - Aunsholt, Lise
AU - Canvasser, Jennifer
AU - Pryor, Erin
AU - Martin, Camilia Cami R
AU - Meehan, Judith
AU - Molloy, Eleanor J
N1 - © 2026. The Author(s), under exclusive licence to Springer Nature America, Inc.
PY - 2026/9/19
Y1 - 2026/9/19
N2 - BACKGROUND AND AIMS: Necrotizing Enterocolitis (NEC) is a significant cause of morbidity and mortality for preterm neonates. Although Bell's criteria are frequently used to assess stage of NEC, it was not a definition and, since its inception in 1978 and with the survival of neonates at earlier gestations, there is a requirement for an updated NEC definition. This systematic review aimed to evaluate the use of criteria for the diagnosis and staging of NEC in randomised clinical control trials.METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted through PubMed to identify Randomised Control Trials (RCTs) in the last twenty years that used NEC in the study title and in either the primary outcome or the inclusion criterion.RESULTS: The initial search identified fifty-six RCTs. Thirty-six RCTs were included for full-text analysis. Thirty-three trials used Bell's criteria or Modified Bell's criteria to define NEC and three RCTs unique, author-created definitions.CONCLUSIONS: There is consistent use of Bell's and Modified Bell's criteria of necrotizing enterocolitis in RCTs. However, international consensus on further modifications of the definition will greatly contribute to both research and clinical practice relating to NEC, in allowing greater consistency in the staging of NEC, and therefore optimal management.
AB - BACKGROUND AND AIMS: Necrotizing Enterocolitis (NEC) is a significant cause of morbidity and mortality for preterm neonates. Although Bell's criteria are frequently used to assess stage of NEC, it was not a definition and, since its inception in 1978 and with the survival of neonates at earlier gestations, there is a requirement for an updated NEC definition. This systematic review aimed to evaluate the use of criteria for the diagnosis and staging of NEC in randomised clinical control trials.METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted through PubMed to identify Randomised Control Trials (RCTs) in the last twenty years that used NEC in the study title and in either the primary outcome or the inclusion criterion.RESULTS: The initial search identified fifty-six RCTs. Thirty-six RCTs were included for full-text analysis. Thirty-three trials used Bell's criteria or Modified Bell's criteria to define NEC and three RCTs unique, author-created definitions.CONCLUSIONS: There is consistent use of Bell's and Modified Bell's criteria of necrotizing enterocolitis in RCTs. However, international consensus on further modifications of the definition will greatly contribute to both research and clinical practice relating to NEC, in allowing greater consistency in the staging of NEC, and therefore optimal management.
UR - https://www.scopus.com/pages/publications/105051433701
U2 - 10.1038/s41372-026-02905-5
DO - 10.1038/s41372-026-02905-5
M3 - Review
C2 - 42763344
SN - 0743-8346
JO - Journal of Perinatology
JF - Journal of Perinatology
ER -