Screening and evaluation
Children presenting with neutropenia and gastrointestinal symptoms were
screened. After excluding patients with acute gastritis, acute
pancreatitis and acute appendicitis by appropriate clinical evaluation
and investigations, informed consent was taken and were enrolled in the
study.
The enrolled patients subsequently underwent CECT abdomen. Based on the
physical findings and radiological investigations, they were classified
into: Definite and probable NEC and NEC excluded. Patients with definite
and probable NEC underwent further evaluation, which included serial
blood counts, bacterial and fungal work up for isolation of offending
organism, stool work up and blood CMV PCR.
Children diagnosed as definite and probable NEC were treated according
to institutional protocol, which included intravenous antibiotics, bowel
rest, intravenous fluids, correction of electrolyte imbalances,
transfusion support, parenteral nutrition and growth factors. Surgical
intervention was considered in case of complications like perforation,
uncontrolled haemorrhage and uncontrolled sepsis despite appropriate
intravenous antibiotics. They were followed up till discharge. The
outcome variables including death or discharge, duration of hospital
stay, duration of bowel rest and requirement of vasoactive agents and
mechanical ventilation were recorded.
Faecal microbiota and faecal calprotectin were analysed in the enrolled
patients and healthy controls. Healthy controls included siblings of
children with cancer, and were required to be asymptomatic and not
having received any antibiotics in the preceding one month.