Background. To find the predictor of optimal surgical timing for neonatal necrotizing enterocolitis (NEC) patients by analyzing the risk factors of conservative treatment and surgical therapy. Methods. Data were collected from 184 NEC patients (Surgery, n=41; conservative treatment, n=143) between the years 2015 and 2019. Data were analyzed by univariate analysis, and multivariate binary logistic regression analysis. Results. Univariate analysis showed that statistically significant differences between the surgery and conservative treatment groups. The results of multivariate Logistic regression analysis indicated intestinal wall thickening by B-ultrasound and gestational age were independent factors to predict early surgical indications of NEC (p < 0.05). The true positive rate, false positive rate, true negative rate and false negative rate in the diagnosis of necrotic bowel perforation guided by DAAS (Duke abdominal X-ray score) ≥7 and MD7 (seven clinical metrics of metabolic derangement) ≥3 were 12.8%, 0.0%, 100.0% and 87.2%, respectively. Conclusions. In summary, the ultrasound examination in NEC children showing thickening intestinal wall and poor intestinal peristalsis indicated for early operation.

BackgroundThe current indications based on the clinicopathological parameters for predicting the need for surgery in neonatal necrotizing enterocolitis (NEC) are still limited. This study retrospectively analyzes the characteristics of neonatal NEC and aims to identify the risk factors for surgical intervention in NEC.MethodsData of the NEC cases from 2015 to 2019 were collected from our institution and divided into two groups: surgical group (n = 41) and conservative treatment group (n = 143). Clinical, physical, and laboratory measures were analyzed by univariate analysis and multivariate logistic regression. The diagnostic values and receiver operative characteristic (ROC) curve were used for the assessment.ResultsUnivariate analysis identified significant differences between the surgical group and the conservative group in a series of clinical, physical, and laboratory measures (all p < 0.05). The results of multivariate logistic regression analysis showed that procalcitonin (adjusted OR: 167.1, 95% CI, 3.585–7,788.758, p = 0.009) and gestational age (adjusted OR: 0.85, 95% CI, 0.77–0.94, p = 0.001) were independent surgical indications for NEC. The results from ROC curve and diagnosis values demonstrated that procalcitonin [the area under the curve (AUC) = 0.864], CRP (AUC = 0.783) and fibrinogen (AUC = 0.720) had good predictive performance for surgical NEC.ConclusionsThe level of procalcitonin and gestational age were found to be independent surgical indications for neonates with NEC.