Association between prognostic factors and the clinical deterioration of preterm neonates with necrotizing enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is responsible for most morbidity and mortality in neonates. Early recognition of the clinical deterioration in newborns with NEC is essential to enhance the referral and management and potentially improve the outcomes. Here, we aimed to identify the prognostic factors and associate them with the clinical deterioration of preterm neonates with NEC. We analyzed the medical records of neonates with NEC admitted to our hospital from 2016 to 2021. We ascertained 214 neonates with NEC. The area under the receiver operating characteristic (ROC) curve and cut-off level of age at onset, C-reactive protein (CRP), leukocyte count, and platelet count for the clinical deterioration of preterm neonates with NEC was 0.644 and 10.5 days old, 0.694 and 4.5 mg/L, 0.513 and 12,200/mm3, and 0.418 and 79,500/mm3, respectively. Late-onset, history of blood transfusion, thrombocytopenia, and elevated CRP were significantly associated with the clinical deterioration of neonates with NEC (p = < 0.001, 0.017, 0.001, and < 0.001, respectively), while leukocytosis, gestational age, and birth weight were not (p = 0.073, 0.274, and 0.637, respectively). Multivariate analysis revealed that late-onset and elevated CRP were strongly associated with the clinical deterioration of neonates with NEC, with an odds ratio of 3.25 (95% CI = 1.49–7.09; p = 0.003) and 3.53 (95% CI = 1.57–7.95; p = 0.002), respectively. We reveal that late-onset and elevated CRP are the independent prognostic factor for the clinical deterioration of preterm neonates with NEC. Our findings suggest that we should closely monitor preterm neonates with NEC, particularly those with late-onset of the disease and those with an elevated CRP, to prevent further clinical deterioration and intervene earlier if necessary.

Necrotising enterocolitis in a middle‐income country: Early onset and risk factors for mortality

“…Neonates requiring red blood cell or platelet transfusion had an increased risk of dying from NEC which was in keeping with other studies 15 . Maheshwari 30 also denoted that a rapid drop in platelets to a level less than 100 × 10 9 /L within 12–24 h of disease onset correlates with severe NEC may indicate a likelihood of bowel necrosis and the need for surgical intervention.…”

“…Neonates requiring red blood cell or platelet transfusion had an increased risk of dying from NEC which was in keeping with other studies. 15 Maheshwari 30 also denoted that a rapid drop in platelets to a level less than 100 × 10 factor NEC progression, and the authors recommended serial CRP monitoring to detect clinical deterioration. 15 In the GSH study, neonates with hyponatraemia at the onset of NEC had a higher risk of mortality, consistent with results from a study by Palleri et al, 14 which showed that neonates with hyponatraemia at the onset of NEC are more likely to undergo surgery and die within 2 weeks of diagnosis.…”

“…These include: being born SGA, low Apgar scores, advanced stage NEC, lactic acidosis, hyponatraemia, severe anaemia and severe thrombocytopenia 13,14 . A raised C‐reactive protein (CRP) has been reported to be an independent prognostic factor for clinical deterioration in neonates with NEC 15 …”

“…13,14 A raised C-reactive protein (CRP) has been reported to be an independent prognostic factor for clinical deterioration in neonates with NEC. 15 There is a paucity of data about NEC from South Africa and other LMICs where the incidence has been reported to be higher.…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…A study concluded that substantial hsCRP increases in chronic gastritis patients could potentially indicate the severity of acute/chronic mucosal inflammation and the presence of Helicobacter Pylori (HP) infection [ 925 ]. CRP can be a useful marker for differentiating between food protein-induced enterocolitis syndrome and food protein-induced proctocolitis, whereas both stage II and III necrotizing enterocolitis complications in neonatals could possibly be predicted by persistently increased CRP after suitable medical management [ 926 , 927 ]. Except for campylobacter enteritis, in which CRP can be notably raised, old data suggest that CRP > 12 mg/L could be a useful tool for predicting children bacterial gastroenteritis, but a more recent study found that CRP > 95 mg/L during the first 48 h is suggestive of bacterial gastroenteritis [ 928 , 929 ].…”