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

Pediatric Research (2024)Cite this article

A Correction to this article was published on 30 April 2024

This article has been updated

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.

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Fig. 1: Study flowchart.
Fig. 2: Hematological patterns in preterm infants compared between medical NEC (m-NEC) and surgical NEC (s-NEC) in three different gestational age (GA) groups.
Fig. 3: Percent changes in peripheral blood.
Fig. 4: Predictive values of PLT, ALC, and CRP for surgical intervention of NEC patients.
Fig. 5: Predictive values of PLT and Hct for non-survivor surgical NEC patients.

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Data availability

All data generated and analyzed during this study are included in this article and its supplementary information files.

Change history

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Funding

This work was supported by the grants from National Natural Science Foundation of China to Z.L. (No.82171696) and L.L. (No.82001591).

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Author notes

  1. These authors contributed equally: Qingqi Chong, Zhiru Wang.

Authors and 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

    Qingqi Chong, Zhiru Wang, Ting Guo, Liaoran Zhang, Li Lu, Zhibao Lv & Qingfeng Sheng

  2. Department of Neonatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355, Luding Rd, 200062, Shanghai, PR China

    Cheng Cai & Xiaohui Gong

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Contributions

Material preparation, data collection, analysis, and the first draft of the manuscript were performed by Q.C. and Z.W. T.G., L.Z., and L.L. contributed to the concept and design, analysis, and validation of data. C.C. and X.G. contributed to the acquisition of data and revising it critically for important intellectual content. Q.S. and Z.L. contributed to the concept and design, supervision, validation, and reviewing and editing. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhibao Lv or Qingfeng Sheng.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethics Board of Shanghai Children’s Hospital (IRB: 2020R089-F01).

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Informed consent was obtained from both parents and/or legal guardians of all infants included in the study.

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The original online version of this article was revised. Due to a typesetting mistake, the following statement was missing from the published article: “The authors Qingqi Chong and Zhiru Wang contributed equally to this article.”

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Chong, Q., Wang, Z., Guo, T. et al. Gestational age-specific hematological features in preterm infants with necrotizing enterocolitis. Pediatr Res (2024). https://doi.org/10.1038/s41390-023-02999-z

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