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.