{"id":300,"date":"2013-02-12T17:46:29","date_gmt":"2013-02-12T16:46:29","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc-archimedes\/?p=300"},"modified":"2013-03-15T17:15:06","modified_gmt":"2013-03-15T16:15:06","slug":"chorio-and-nec","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2013\/02\/12\/chorio-and-nec\/","title":{"rendered":"Chorioamnionitis and NEC &#8211; the challenge of significant small associations"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" alt=\"Cover image\" src=\"http:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0022347612X00131-cov150h.gif\" width=\"112\" height=\"150\" \/>In a recent flurry of twittering, Archimedes noticed a <a href=\"http:\/\/t.co\/u7YaBrNF\">meta-analysis linking chorioamnionitis with necrotising enterocolitis<\/a>. Although a long time since doing neonates has passed, the consequences of NEC were profound enough to stick, and a potential association, perhaps a route in to stopping it happen, would be welcome.<\/p>\n<p>The meta-analysis showed that, on univariate examination, there was a positive relationship between clinical chorioamninonitis and significant NEC (Bell stage 2 or worse), with an OR of approximately 1.3.<\/p>\n<p>To convert this to something more clinically useful &#8211; say, the proportion of chorioamnionitis-born-babies who&#8217;d develop NEC, and the proportion who didn&#8217;t have a mum with CC but got NEC anyway &#8211; needed to know approximate average rates of NEC and CC.<\/p>\n<p><!--more-->A <a href=\"http:\/\/pediatrics.aappublications.org\/content\/early\/2012\/01\/18\/peds.2011-2022.full.pdf\">large multicentre US study by Yee<\/a> helps us out here, with around 5% of preterm infants getting NEC and about 11% on non-NEC babies having mums with CC.\u00a0Popping these values into a theoretical cohort of 1000 neonates leads to:<\/p>\n<table width=\"192\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<colgroup>\n<col span=\"3\" width=\"64\" \/><\/colgroup>\n<tbody>\n<tr>\n<td width=\"64\" height=\"20\"><\/td>\n<td width=\"64\">NEC<\/td>\n<td width=\"64\">Not<\/td>\n<\/tr>\n<tr>\n<td height=\"20\">CC<\/td>\n<td align=\"right\">7<\/td>\n<td align=\"right\">105<\/td>\n<\/tr>\n<tr>\n<td height=\"20\">Not<\/td>\n<td align=\"right\">43<\/td>\n<td align=\"right\">845<\/td>\n<\/tr>\n<tr>\n<td height=\"20\"><\/td>\n<td align=\"right\">50<\/td>\n<td align=\"right\">950<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>The positive predictive value of CC for NEC is about 6.2%, and the rate of &#8216;unsuspected&#8217; NEC in the non-CC group would be 4.8%<\/p>\n<p>This highlights the trouble with relative measures of association in relatively rare conditions; you don&#8217;t actually end up knowing a lot more than when you started.<\/p>\n<p>Archi<\/p>\n<p>(Many thanks for the leads into this from <a href=\"http:\/\/www.twitter.com\/PaedsRH\">@PaedsRH<\/a> and <a href=\"http:\/\/twitter.com\/jfpohl\">@Jfphol<\/a>)<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In a recent flurry of twittering, Archimedes noticed a meta-analysis linking chorioamnionitis with necrotising enterocolitis. Although a long time since doing neonates has passed, the consequences of NEC were profound enough to stick, and a potential association, perhaps a route in to stopping it happen, would be welcome. The meta-analysis showed that, on univariate examination, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/02\/12\/chorio-and-nec\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79],"tags":[],"class_list":["post-300","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chorioamnionitis and NEC - the challenge of significant small associations - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2013\/02\/12\/chorio-and-nec\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chorioamnionitis and NEC - the challenge of significant small associations - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"In a recent flurry of twittering, Archimedes noticed a meta-analysis linking chorioamnionitis with necrotising enterocolitis. 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