Predicting the risk of reoperative intervention for adhesive bowel obstruction in neonates: The neonatal adhesion risk score (NARS).

OBJECTIVE

To develop and validate a simple, preoperative risk score based on fundamental patient characteristics to predict the need for reoperation for adhesive small bowel obstruction (ASBO) in neonates undergoing laparotomy.

METHODS

In this retrospective cohort study of 410 neonates undergoing laparotomy at a single tertiary center (2008-2019), we identified independent predictors for the primary outcome of "first reoperation for surgically confirmed ASBO" using multivariable Cox regression. Predictors were selected from universally available preoperative variables. The resulting Neonatal Adhesion Risk Score (NARS) was validated on the same cohort.

RESULTS

Four independent preoperative predictors were identified: 1) high-risk primary diagnosis (HR 3.8, 95% CI 2.1-6.9), 2) gestational age <34 weeks (HR 2.0, 95% CI 1.2-3.4), 3) presence of major associated congenital anomalies (HR 1.6, 95% CI 1.1-2.4), and 4) birth weight <1500 g (HR 1.4, 95% CI 1.0-2.0). High-risk diagnoses included gastric perforation, jejunal atresia, meconium ileus, and necrotizing enterocolitis (NEC). The NARS stratified patients into low (0-2 points), moderate (3-4 points), and high-risk (≥5 points) groups, with observed reoperation rates for ASBO of <10%, 25-35%, and >50%, respectively. The high-risk group accounted for nearly half of all first reoperations and had a significantly shorter median time to reoperation (7 vs. 24 days, p < 0.001).

CONCLUSION

The NARS is a clinically applicable, preoperative tool that effectively identifies neonates at high risk for early and recurrent surgical intervention for ASBO. By utilizing readily available clinical data, it enables targeted surveillance, informed family counseling, and a rational framework for considering adjuvant anti-adhesion strategies in the most vulnerable patients.