Gestational Age-Specific Complete Blood Count Signatures in Necrotizing Enterocolitis

Abstract

Objective: Necrotizing enterocolitis (NEC) is characterized by peripheral cell abnormalities, yet few studies have analyzed the complete blood count (CBC) specifically by gestational age (GA). Our objective was to describe GA-specific immune abnormalities in NEC through a comprehensive analysis of the CBC differential.Methods: Using a cohort of 246 infants (177 cases, 69 controls) admitted to neonatal intensive care units at a single institution, we retrospectively analyzed CBCs around illness onset in NEC cases compared with controls. Cases included surgical NEC (S-NEC, 34.5%) and medical NEC (M-NEC, 65.5%). Infants were divided into those born at GA <33 and ≥33 weeks. Differences in CBC values were described as absolute and percent changes at NEC onset from baseline and at antibiotic completion after NEC. We used machine learning algorithms based on the CBC at NEC to generate predictive models for diagnosis.Results: At NEC onset, there was an acute drop in monocytes and lymphocytes along with a rise in bands in S-NEC infants born <33 weeks compared with M-NEC. In comparison, both M-NEC and S-NEC ≥33 weeks had a percent drop in neutrophils at diagnosis compared with controls. At antibiotic completion, monocytes in S-NEC <33 weeks significantly rose compared with M-NEC, yet for S-NEC ≥33 weeks, bands significantly dropped compared with M-NEC. Predictive modeling was able to accurately predict S-NEC from M-NEC and controls.Conclusion: There are discrete leukocyte patterns in NEC based on GA. The CBC at diagnosis may be useful in identifying patients who will require surgery.

Association of neutropenia at disease onset with severe surgical necrotizing enterocolitis and higher mortality: A retrospective study

“…Grag et al have previously demonstrated that children with fulminant NEC are more prone to neutropenia and thrombocytopenia ( 16 ). Julia et al have demonstrated that surgical NEC ≥33 weeks had a percent drop in neutrophils at diagnosis of NEC ( 17 ). Experimental studies have also suggested that neutrophils are equally important in NEC as in acute intestinal inflammation.…”

Framework for feature selection of predicting the diagnosis and prognosis of necrotizing enterocolitis

“…As an example, let n = 20 and filp = 5, where n denotes the number of features in Refsol. If the index of features are 0 to 19, feature subsets f 0 , f 1 , f 2 , f 3 and f 4 are obtained by flipping the following bits, as shown in Fig 4: (0,5,10,15), (1,6,11,16), (2,7,12,17), (3,8,13,18) and (4,9,14,19). In the second strategy, the k-th subset of features is obtained by flipping n/flip contiguous bits starting from the k-th bit.…”

“…In the second strategy, the k-th subset of features is obtained by flipping n/flip contiguous bits starting from the k-th bit. Following the previous example, the feature subsets f 0 , f 1 , f 2 , f 3 and f 4 are obtained by flipping the following bits: (0,1,2,3), (4,5,6,7), (8,9,10,11), (12,13,14,15) and (16,17,18,19). With the above two searching strategies, we determine the search area for each bee.…”

“…In the feature selection stage, they use statistical analysis to extract important features. In the classification stage, most researchers use ML methods such as linear discriminant analysis (LDA) [14,15], random forest (RF) [16][17][18], or Light Gradient Boosting Machine (GBM) [19] as classifier models. Table 1 summarizes some studies using ML for the diagnosis or prognosis of NEC.…”

Human Milk Growth Factors and Their Role in NEC Prevention: A Narrative Review

“…G-CSF has been studied as a potential therapy for infants with neutropenia and sepsis. Neutropenia may be a risk factor for the development of NEC and has been associated with worsened prognosis [104,105]. Using G-CSF to prevent or improve neutropenia could in theory offer some protection from the development of NEC.…”