Gestational age-specific hematological features in preterm infants with necrotizing enterocolitis

Qingqi Chong; Zhiru Wang; Ting Guo; Liaoran Zhang; Li Lu; Cheng Cai; Xiaohui Gong; Zhibao Lv; Qingfeng Sheng

doi:10.1038/s41390-023-02999-z

Gestational age-specific hematological features in preterm infants with necrotizing enterocolitis

Pediatr Res. 2024 Jan 4. doi: 10.1038/s41390-023-02999-z. Online ahead of print.

Authors

Qingqi Chong^#¹, Zhiru Wang^#¹, Ting Guo¹, Liaoran Zhang¹, Li Lu¹, Cheng Cai², Xiaohui Gong², Zhibao Lv³, Qingfeng Sheng⁴

Affiliations

¹ Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Rd, 200062, Shanghai, PR China.
² Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Rd, 200062, Shanghai, PR China.
³ Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Rd, 200062, Shanghai, PR China. zhibaolyu@163.com.
⁴ Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Rd, 200062, Shanghai, PR China. shengqingfeng@hotmail.com.

^# Contributed equally.

PMID: 38177247
DOI: 10.1038/s41390-023-02999-z

Abstract

Background: This study aimed to investigate gestational age-specific hematological features in preterm infants with necrotizing enterocolitis (NEC) and identify predictive hematological biomarkers for surgical NEC.

Methods: We conducted a retrospective study comparing gestational age (GA)-specific clinical data between medical NEC (m-NEC) and surgical NEC (s-NEC) subgroups, stratified by GA as <28 weeks, 28 ≤ GA < 32 weeks, and 32 ≤ GA < 37 weeks. Multivariate logistic analysis and receiver operating characteristic curve were used to identify the independent predictors of s-NEC.

Results: In comparison to m-NEC at NEC onset, s-NEC infants exhibited the following findings: In GA < 28 weeks, s-NEC infants had lower platelet counts. In 28 ≤ GA < 32 weeks, lower absolute lymphocyte counts, and significant percent drop in platelets, lymphocytes, and monocytes were observed. In 32 ≤ GA < 37 weeks, lower absolute lymphocyte counts and significant percent drop in lymphocytes were found. Independent predictors were able to distinguish s-NEC from m-NEC. The area under the curve (AUC) for platelet counts in GA < 28 weeks was 0.880, while C-reactive protein in 28 ≤ GA < 32 weeks had an AUC of 0.889. The AUC for lymphocyte counts in 32 ≤ GA < 37 weeks was 0.892.

Conclusion: This study identified hematological abnormalities in the development of NEC based on gestational age. Independent predictors may help clinicians distinguish surgical NEC from medical NEC.

Impact: Necrotizing enterocolitis (NEC) patients with different gestational ages (GA) exhibit different hematological features and independent predictors of surgical NEC differ among different GAs. Our research made the current studies about peripheral hematological features with NEC more complete by analyzing peripheral data collected within 24 h of birth, at day 5-7, day 3-4, day 1-2 before NEC onset, at the time of NEC onset, day 1, day 2, day 3, day 4-5, day 6-7 after NEC onset. Our study is helpful to clinicians in developing a more detailed diagnostic strategy based on GA for the early identification of surgical NEC.