The value of blood eosinophils count in infants with feeding intolerance in the neonatal intensive care setting

Abstract

Objectives: We aimed to assess the relationship between feeding intolerance or necrotizing enterocolitis (NEC), and neonatal blood eosinophilc counts >700 cells/mm3 (eosinophilia) in the first 28 days of life.Methods: In this prospective observational cohort study, the highest and the average absolute eosinophil counts were recorded for each infant. Date of onset at first enteral feed, type of milk, time taken to reach full oral feeding, and incidence of feeding intolerance were also noted.Results: A total of 486 infants admitted to the neonatal intensive care unit with 1171 complete blood cell count samples drawn were observed. Eosinophilia (count >700/mm 3 ) was noted in 106 infants (22%). When compared to infants without eosinophilia (n = 380) infants with eosinophilia had significantly younger gestational age. Fourteen percent of infants with eosinophilia compared with 6% of the controls developed feeding intolerance (OR 2.86, 95% CL 1.40-5.68). Moreover, infants with eosinophilia were less likely to achieve full feeds in one week (OR 0.48, 95% CL 0.30-0.76) or two weeks (OR 0.37, 95% CL 0.21-0.65) as compared to their controls respectively. However, after gestational age adjustment only exclusive formula feeding was found to have a significant association with eosinophilia (OR 1.76, 95% CL 1.07-2.89). Of other secondary factors evaluated only antenatal antibiotics (OR 2.29,) and total parenteral nutrition (TPN) (OR 2.99, 95% CL 1.32-6.77) continued to maintain statistical significance after gestational age adjustment.Conclusions: Eosinophilia is more likely in infants who are premature, receiving TPN, exclusively formula-fed, and whose mothers received antenatal antibiotics. Eosinophilia does not independently correlate with either feeding intolerance or NEC.