Table 1.

Modified Bell’s staging criteria for necrotizing enterocolitis

Stage	Classification	Systemic signs	Intestinal signs	Radiologic signs
IA	Suspected NEC	Bradycardia, lethargy	Mild abdominal distention, vomiting, occult fecal blood	Normal mild ileus
IB	Suspected NEC	Same as above	Macroscopic rectal bleeding	Same as above
IIA	Proven NEC-mildly ill	Same as above	Same as above, + absent bowel sounds, ± tenderness	Intestinal dilation, ileus, pneumatosis intestinalis
IIB	Proven NEC-moderately ill	Same as above, + mild metabolic acidosis and/or thrombocytopenia	Same as above+absent bowel sounds, definite tenderness±abdominal cellulitis or mass	Same as IIA, + portal venous gas, ± ascites
IIIA	Advanced NEC - severely ill, bowel intact	Same as IIB, + hypotension, disseminated intravascular coagulation	Same as above, + signs of generalized peritonitis, marked tenderness, and distention of abdomen	Same as IIB, + definite ascites
IIIB	Advanced NEC - severely ill, bowel perforated	Same as IIIA	Same as IIIA	Same as IIB, + pneumoperitoneum

NEC: Necrotizing enterocolitis