Objects Necrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify risk factors of NEC and predict surgical NEC.
Methods According to the modified Bell’s staging criteria, 235 neonates with NEC admitted between Jan 1, 2015 and Sep 30, 2019 were divided into surgical group (n=47) and conservative group (n=188). Data concerning clinical characteristics and therapeutic management were collected. Infection values of WBC, N%, PLT, CRP, PCT were measured before treatment (T0), on the next day after treatment (T1).
Results 1. Surgical group were associated with gestational age, small for gestational age, add milk before onset of NEC, hospitalization expense compared to conservative group (p=0.040, 0.048, 0.045, 0.011), in addition to N%0, N%1, PLT1, CRP1 and PCT1 (p=0.049, 0.003, 0.018, <0.001, 0.003). There was significant difference in NEC among Bell stage I, II and III between surgical group and conservative group (χ2=49.358, p<0.001). 2. Regression analysis showed that Bell stage I, II and III NEC (OR 12.331, 6.315, p=0.038, 0.025), N%1 (OR 0.959, p=0.032), CRP1 (OR 0.978, p=0.039) and PCT1 (OR 0.983, p=0.036), add milk before onset of NEC (OR 7.117, p=0.021) were all independent risk factors to predict surgical NEC. 3. The AUC of combined Bell stage I, II and III NEC, N%1, CRP1, PCT1, add milk the day before onset of NEC (P) in predicting surgical NEC was 0.924 (95%CI 0.865~0.983, p<0.001). The ideal cutoff value of P was 0.729, with a sensitivity of 85.7% and specificity of 87.5%.
Conclusion Increased Levels of CRP1, PCT1, N%1, Bell stage I, II and III, and add milk the day before onset of NEC are all independent risk factors of NEC, and combined of them can be used to predict the development of surgical NEC.