Table 1.

Modified Bell Staging Criteria for NEC

Stage	Classification	Systemic signs	Intestinal signs	Radiologic signs
IA	Suspected NEC	Temperature instability, apnea, bradycardia, lethargy	Increased pregavage residuals, mild abdominal distention, emesis, guaiac-positive stool	Normal or intestinal dilation, mild ileus
IB	Suspected NEC	Same as above	Bright red blood from rectum	Same as above
IIA	Proven NEC – mildly ill	Same as above	Same as above, plus absent bowel sounds, with or without abdominal tenderness	Intestinal dilation, ileus, pneumatosis intestinalis
IIB	Proven NEC – moderately ill	Same as above, plus mild metabolic acidosis, mild thrombocytopenia	Same as above, plus absent bowel sounds, definite abdominal tenderness, with or without abdominal cellulitis or right lower quadrant mass	Same as IIA, plus portal venous gas, with or without ascites
IIIA	Advanced NEC – severely ill, bowel intact	Same as IIB, plus hypotension, bradycardia, severe apnea, combined respiratory and metabolic acidosis, disseminated intravascular coagulation, and neutropenia	Same as above, plus signs of generalized peritonitis, marked tenderness, and distention of abdomen	Same as IIB, plus definite ascites
IIIB	Advanced NEC – severely ill, bowel perforated	Same as IIIA	Same as IIIA	Same as IIB, plus pneumoperitoneum

Adapted from Lee & Polin, 2003