Staging
Modified Bell classification
The Walsh and Kliegman modification of Bell's staging grades necrotizing enterocolitis from suspected through definite to advanced disease using clinical signs and abdominal radiographs.
Also called: modified Bell staging, modified Bell criteria
Stages
- I
Suspected
Non-specific systemic and intestinal signs with a normal radiograph or mild ileus.
Sub-stages
- IA
- Temperature instability, apnea, lethargy or feeding problems, with a distended abdomen and heme-positive stool.
- IB
- The same picture together with a grossly bloody stool.
- II
Definite
Characteristic intestinal signs with pneumatosis intestinalis on the radiograph.
Sub-stages
- IIA
- Mildly ill with absent bowel sounds and pneumatosis intestinalis.
- IIB
- Moderately ill with metabolic acidosis or a low platelet count, and portal vein gas may be present.
- III
Advanced
Severely ill with systemic deterioration, shock or peritonitis.
Sub-stages
- IIIA
- Severely ill with an intact bowel on the radiograph and no perforation.
- IIIB
- Severely ill with a perforated bowel and free air in the abdomen.
Judged onClinical signs, systemic illness and abdominal radiograph findings