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Comparison of preoperative and intraoperative surgeon diagnosis and pathologic findings in spontaneous intestinal perforation vs necrotizing enterocolitis

Journal of Perinatology volume 44, pages 568–574 (2024)Cite this article

Subjects

Abstract

Objective

To investigate the accuracy of preoperative and intraoperative diagnosis via comparison to pathologic diagnosis in spontaneous intestinal perforation (SIP) vs. necrotizing enterocolitis (NEC).

Study design

A retrospective review of neonates <1500 g treated for pneumoperitoneum between 07/2004-09/2022 was conducted. Patients treated for NEC medically prior to diagnosis and those treated with drain only were excluded. Fleiss’ Kappa analysis assessed agreement between all three diagnoses: preoperative, intraoperative, and pathologic.

Result

Overall, 125 patients were included with mean birthweight 834.2 g (SD:259.2) and mean gestational age 25.8 weeks (SD:2.2). Preoperative and intraoperative diagnoses agreed in 90.3%, intraoperative and pathologic agreed in 71.1%, and preoperative and pathologic agreed in 75.2% of patients. Fleiss’ Kappa was 0.55 (95% CI:0.43,0.68), indicating moderate agreement between the three diagnoses.

Conclusion

Our study shows moderate agreement between preoperative, intraoperative, and pathologic diagnoses. Further studies investigating the clinical characteristics of SIP and NEC are needed to improve diagnostic accuracy and management.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the primary investigator, Amina M. Bhatia, on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Surgery, Emory University, Atlanta, GA, USA

    Olivia A. Keane & Goeto Dantes

  2. Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Valerie L. Dutreuil

  3. Emory University School of Medicine, Emory University, Atlanta, GA, USA

    Louis Do & Savanah Rumbika

  4. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Pamela B. Sylvestre

  5. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Amina M. Bhatia

Authors
  1. Olivia A. Keane
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  4. Louis Do
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  7. Amina M. Bhatia
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Contributions

AMB was the principal investigator responsible for study conception and design and data collection supervision. OAK, GD, and AMB conceptualized the study. OAK, GD, LD, and SR conducted data collection. VD conducted the analyses, wrote initial drafts of the Methods and Statistical Analysis. VD and PBS prepared tables and figures. OAK drafted the manuscript and took part in crucial edits. GD, LD, SR, PBS, and AMB provided feedback on drafts. OAK, GD, VD, and AMB had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Olivia A. Keane.

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Keane, O.A., Dantes, G., Dutreuil, V.L. et al. Comparison of preoperative and intraoperative surgeon diagnosis and pathologic findings in spontaneous intestinal perforation vs necrotizing enterocolitis. J Perinatol 44, 568–574 (2024). https://doi.org/10.1038/s41372-024-01876-9

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