Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The complete blood cell count in a refined cohort of preterm NEC: the importance of gestational age and day of diagnosis when using the CBC to estimate mortality

Journal of Perinatology volume 36, pages 121–125 (2016)Cite this article

Subjects

Abstract

Objective:

The value of the white blood cell count (WBC) in necrotizing enterocolitis (NEC) is controversial. One reason for this confusion may be that the various WBC lineages change substantially with increasing gestational age and thereby age of NEC onset. This study postulated that if a data set was large enough and the diagnosis of NEC clean enough, absolute WBC counts would facilitate prediction of NEC mortality. The objective of this study was to determine whether absolute WBC counts enhance the prediction of NEC mortality.

Study Design:

A de-identified data subset from the Pediatrix national data set specific to the diagnoses of NEC in patients who had a CBC drawn on the day of diagnosis (exclusive of the diagnoses of spontaneous intestinal perforations and congenital anomalies) was the target for analysis. Values of primary interest included: gestation, day of diagnosis, absolute WBC count, platelet count, hematocrit, mortality and the day of diagnosis. Stepwise regression analysis was used to predict mortality.

Result:

A total of 4059 (79%) survivors and 1107 (21%) infants who died with a diagnosis of medical or surgical NEC were included in the data set. Associations with mortality were found with low gestational age, low platelet count, low hematocrit, high band/segmented neutrophil ratio, earlier day of diagnosis, high birth weight z-score, non-white race, no antenatal steroids in gestations above 24 weeks, absolute lymphocyte count adjusted for gestational age, and absolute monocyte count high and low values. A stepwise regression analysis yielded a receiver-operator curve of 0.819 with a sensitivity of 65% and specificity of 84%.

Conclusion:

Absolute WBC values enhance prediction of NEC survival when used in combination with readily available data on the day of NEC diagnosis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Kim JH . Necrotizing enterocolitis: the road to zero. Semin Fetal Neonatal Med 2014; 19 (1): 39–44.

    Article  Google Scholar 

  2. Christensen RD, Gordon PV, Besner GE . Can we cut the incidence of necrotizing enterocolitis in half—today? Fetal Pediatr Pathol 2010; 29 (4): 185–198.

    Article  CAS  Google Scholar 

  3. Benjamin J, Chong E, Reynolds J, Gordon PV . Detailed analysis of NEC risks across a decade in a low incidence NICU: can we drive the incidence of NEC toward zero? EJ Neonatol Res 2012; 2: 182–189.

    Google Scholar 

  4. Ellsbury DL, Ursprung R . A quality improvement approach to optimizing medication use in the neonatal intensive care unit. Clin Perinatol 2012; 39 (1): 1–10.

    Article  Google Scholar 

  5. Bloom BT, Craddock A, Delmore PM, Kurlinski JP, Voelker M, Landfish N et al. Reducing acquired infections in the NICU: observing and implementing meaningful differences in process between high and low acquired infection rate centers. J Perinatol 2003; 23 (6): 489–492.

    Article  Google Scholar 

  6. Gordon PV, Swanson JR, Attridge JT, Clark R . Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria? J Perinatol 2007; 27 (11): 661–671.

    Article  CAS  Google Scholar 

  7. Gordon P, Christensen R, Weitkamp JH, Maheshwari A . Mapping the new world of necrotizing enterocolitis (NEC): review and opinion. EJ Neonatol Res 2012; 2 (4): 145–172.

    PubMed  PubMed Central  Google Scholar 

  8. Gordon PV, Swanson JR . Necrotizing enterocolitis is one disease with many origins and potential means of prevention. Pathophysiology 2014; 21 (1): 13–19.

    Article  Google Scholar 

  9. Gordon PV . Necrotizing enterocolitis (NEC) and darwinism (reviewing the evolutionary basis for NEC). EJ Neonatol Res 2013; 3 (1): 23–30.

    Google Scholar 

  10. Chucri TM, Monteiro JM, Lima AR, Salvadori ML, Kfoury JR Jr, Miglino MA . A review of immune transfer by the placenta. J Reprod Immunol 2010; 87 (1–2): 14–20.

    Article  CAS  Google Scholar 

  11. Cianga P, Medesan C, Richardson JA, Ghetie V, Ward ES . Identification and function of neonatal Fc receptor in mammary gland of lactating mice. Eur J Immunol 1999; 29: 2515–2523.

    Article  CAS  Google Scholar 

  12. Brawand D, Wahli W, Kaessmann H . Loss of egg yolk genes in mammals and the origin of lactation and placentation. PLoS Biol 2008; 6 (3): e63.

    Article  Google Scholar 

  13. Swanson JR, Jilling T, Lu J, Landseadel JB, Marcinkiewicz M, Gordon PV . Ileal immunoglobulin binding by the neonatal Fc receptor: a previously unrecognized mechanism of protection in the neonatal rat model of necrotizing enterocolitis? EJ Neonatol Res 2011; 1 (1): 12–22.

    Google Scholar 

  14. Gordon PV, Clark R, Swanson JR, Spitzer A . Can a national dataset generate a nomogram for necrotizing enterocolitis onset? J Perinatol 2014; 34 (10): 732–735.

    Article  CAS  Google Scholar 

  15. Banyasz I, Bokodi G, Vasarhelyi B, Treszl A, Derzbach L, Szabo A et al. Genetic polymorphisms for vascular endothelial growth factor in perinatal complications. Eur Cytokine Netw 2006; 17: 266–270.

    CAS  PubMed  Google Scholar 

  16. Moonen RM, Paulussen AD, Souren NY, Kessels AG, Rubio-Gozalbo ME, Villamor E . Carbamoyl phosphate synthetase polymorphisms as a risk factor for necrotizing enterocolitis. Pediatr Res 2007; 62: 188–190.

    Article  CAS  Google Scholar 

  17. Sampath V, Le M, Lane L, Patel AL, Cohen JD, Simpson PM et al. The NFKB1 (g.-24519delATTG) variant is associated with necrotizing enterocolitis (NEC) in premature infants. J Surg Res 2011; 169: e51–e57.

    Article  CAS  Google Scholar 

  18. More K, Athalye-Jape G, Rao S, Patole S . Association of inhibitors of gastric acid secretion and higher incidence of necrotizing enterocolitis in preterm very low-birth-weight infants. Am J Perinatol 2013; 30 (10): 849–856.

    Article  Google Scholar 

  19. Woods CW, Oliver T, Lewis K, Yang Q . Development of necrotizing enterocolitis in premature infants receiving thickened feeds using SimplyThick. J Perinatol 2012; 32: 150–152.

    Article  CAS  Google Scholar 

  20. Remon J, Kampanatkosol R, Kaul RR, Muraskas JK, Christensen RD, Maheshwari A . Acute drop in blood monocyte count differentiates NEC from other causes of feeding intolerance. J Perinatol 2014; 34 (7): 549–554.

    Article  CAS  Google Scholar 

  21. Christensen RD, Lambert DK, Gordon PV, Baer VL, Gerday E, Henry E . Neonates presenting with bloody stools and eosinophilia can progress to two different types of necrotizing enterocolitis. J Perinatol 2012; 32 (11): 874–879.

    Article  CAS  Google Scholar 

  22. Christensen RD, Baer VL, Gordon PV, Henry E, Whitaker C, Andres RL, Bennett ST . Reference ranges for lymphocyte counts of neonates: associations between abnormal counts and outcomes. Pediatrics 2012; 129 (5): e1165–e1172.

    Article  Google Scholar 

  23. Sylvester KG, Ling XB, Liu GY, Kastenberg ZJ, Ji J, Hu Z et al. Urine protein biomarkers for the diagnosis and prognosis of necrotizing enterocolitis in infants. J Pediatr 2014; 164 (3): 607–612.e1-7.

    Article  CAS  Google Scholar 

  24. Sylvester KG, Ling XB, Liu GY, Kastenberg ZJ, Ji J, Hu Z et al. A novel urine peptide biomarker-based algorithm for the prognosis of necrotising enterocolitis in human infants. Gut 2014; 63 (8): 1284–1292.

    Article  CAS  Google Scholar 

  25. Evennett NJ, Hall NJ, Pierro A, Eaton S . Urinary intestinal fatty acid-binding protein concentration predicts extent of disease in necrotizing enterocolitis. J Pediatr Surg 2010; 45 (4): 735–740.

    Article  Google Scholar 

  26. Aydemir O, Aydemir C, Sarikabadayi YU, Emre Canpolat F, Erdeve O, Biyikli Z et al. Fecal calprotectin levels are increased in infants with necrotizing enterocolitis. J Matern Fetal Neonatal Med 2012; 25 (11): 2237–2241.

    Article  CAS  Google Scholar 

  27. Stone ML, Tatum PM, Weitkamp JH, Mukherjee AB, Attridge J, McGahren ED et al. Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis. J Perinatol 2013; 33 (11): 847–850.

    Article  CAS  Google Scholar 

  28. Däbritz J, Jenke A, Wirth S, Foell D . Fecal phagocyte-specific S100A12 for diagnosing necrotizing enterocolitis. J Pediatr 2012; 161 (6): 1059–1064.

    Article  Google Scholar 

  29. Murgas Torrazza R, Li N, Young C, Kobeissy F, Chow M, Chen S et al. Pilot study using proteomics to identify predictive biomarkers of necrotizing enterocolitis from buccal swabs in very low birth weight infants. Neonatology 2013; 104 (3): 234–242.

    Article  CAS  Google Scholar 

  30. Tayman C, Tonbul A, Kahveci H, Uysal S, Koseoğlu B, Tatli MM et al. C5a, a complement activation product, is a useful marker in predicting the severity of necrotizing enterocolitis. Tohoku J Exp Med 2011; 224 (2): 143–150.

    Article  CAS  Google Scholar 

  31. Garner CE, Ewer AK, Elasouad K, Power F, Greenwood R, Ratcliffe NM et al. Analysis of faecal volatile organic compounds in preterm infants who develop necrotising enterocolitis: a pilot study. J Pediatr Gastroenterol Nutr 2009; 49 (5): 559–565.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

No funding was secured for this study.

Author information

Authors and Affiliations

  1. Sacred Heart Women’s and Children’s Hospital, Pensacola, FL, USA

    P V Gordon

  2. Pediatrix Corporation, Sunrise, FL, USA

    P V Gordon, R Clark & A Spitzer

  3. Department of Pediatrics, University of Virginia Children’s Hospital, Charlottesville, VA, USA

    J R Swanson

Authors
  1. P V Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J R Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Spitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J R Swanson.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Perinatology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gordon, P., Swanson, J., Clark, R. et al. The complete blood cell count in a refined cohort of preterm NEC: the importance of gestational age and day of diagnosis when using the CBC to estimate mortality. J Perinatol 36, 121–125 (2016). https://doi.org/10.1038/jp.2015.162

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.162

This article is cited by

Search

Advanced search

Quick links