Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis

Garg, Parvesh Mohan; O’Connor, Anna; Ansari, Abu Yusuf; Vu, Binh Dang; Hobart, Haley L; Paschal, Jaslyn L.; Multani, Harleen; Josephson, Cassandra D.; Okhomina, Victoria

doi:10.1038/s41372-021-01044-3

Cited by 25 publications

(15 citation statements)

References 38 publications

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“…Spontaneous intestinal perforation has been demonstrated to have a low gestational age and low birth weight, which might cause contamination ( 9 ). Getting rid of interference factors, such as SIP and suspected NEC, gestational age, and birth weight were reported as risk factors for severe conditions ( 3 , 4 , 10 ). We agree that they were related to final outcomes, but they were not promising factors to predict rapid disease progression within 48 h following the disease onset.…”

Section: Discussionmentioning

confidence: 99%

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Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Chen

Zhong²,

Hou³

et al. 2023

Front. Pediatr.

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BackgroundNecrotizing enterocolitis (NEC) is a devastating gastrointestinal emergency with significant mortality and morbidity rates. A subset of patients progressed rapidly and underwent surgical intervention within a short period. This study aimed to establish a model to predict the rapid progression of NEC in preterm neonates.MethodsA retrospective study was conducted to review neonates with NEC between December 2015 and April 2019 at the Guangzhou Women and Children's Medical Center. Rapidly progressive NEC was defined as the need for surgical intervention or death within 48 h of NEC onset. Patients were divided into two groups: rapidly progressive NEC (RP-NEC) and non-rapidly progressive NEC (nRP-NEC). Data on demographics, perinatal characteristics, examination variables, and radiographic findings at onset were collected.ResultsA total of 216 preterm neonates with NEC were included in the study, of which 64 had RP-NEC and 152 had nRP-NEC. The mortality rates of patients with RP-NEC and nRP-NEC were 32.8% and 3.28%, respectively. Male sex (p-value, adjusted odds ratio [95% confidence interval]: 0.002, 3.43 [1.57, 7.53]), portal venous gas (0.000, 8.82 [3.73, 20.89]), neutrophils <2.0 × 109/L (0.005, 4.44 [1.59, 12.43]), pH <7.3 (7.2 ≤ pH < 7.3) (0.041, 2.95 [1.05, 8.31]), and pH <7.2 (0.000, 11.95 [2.97, 48.12]) at NEC onset were identified as independent risk factors for RP-NEC. An established model that included the four risk factors presented an area under the curve of 0.801 with 83% specificity and 66% sensitivity.ConclusionAmong preterm neonates with NEC, a significantly higher mortality rate was observed in those with rapid progression. It is recommended that close surveillance be performed in these patients, and we are confident that our established model can efficiently predict this rapid progression course.

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Section: Discussionmentioning

confidence: 99%

“…Of the non-surviving NEC patients, some died from a rapid course, called fulminant NEC, which was considered a sub-category condition. Fulminant NEC accounts for 6.7%-28% of the entire NEC population and is associated with a high mortality rate of 95.7%-100% (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Chen

Zhong²,

Hou³

et al. 2023

Front. Pediatr.

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“…The modified Bell criteria revealed that systemic manifestations of neutropenia were seen at the advanced stage of NEC ( 15 ). 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 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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BackgroundNeutrophils are among the earliest immune cells recruited to the site of an intestinal injury, but their predictive role in the progression of necrotizing enterocolitis (NEC) has not been fully elucidated. This study aimed to evaluate if a reduction in neutrophils at the onset of NEC is associated with severe surgical NEC and/or NEC-associated deaths.MethodsThis is a retrospective cohort study in which neonates underwent surgery due to NEC during 2015–2020. The data on absolute neutrophil count (ANC), before and at the onset of NEC, were collected from the complete blood count results. The primary exposure was the difference in absolute neutrophil count (ΔANC) at NEC onset. The primary outcome was severe surgical NEC, defined as the residual small bowel length after intestinal resection of <30 cm.ResultsA total of 157 neonates were included in this study, of which 53 were diagnosed with severe surgical NEC. A decrease in ANC at the onset of NEC was associated with an increased probability of severe surgical NEC (crude odds ratio [OR] 1.248, 95% CI 1.107–1.407; P = 0.000). ΔANC (area under the curve [AUC] 0.729, 95% CI 0.653–0.797; P < 0.001] was a good predictor for severe surgical NEC. The addition of platelets to ΔANC at NEC onset (AUC 0.738, 95% CI 0.662–0.808; P < 0.001) resulted in a higher AUC and specificity for severe surgical NEC prediction than ΔANC alone. A reduction in the neutrophil count at NEC onset (ΔANC > 0) was associated with adverse outcomes (hazard ratio [HR] 3.48, 95% CI 1.64–7.36) and a lower survival probability (χ2 10.63; P < 0.001).ConclusionA reduction in the ANC at the onset of NEC was associated with severe surgical NEC and higher mortality. The addition of platelets to ΔANC at NEC onset resulted in a higher predictive value of severe surgical NEC. This study may provide a new insight into the bedside evaluation of NEC by analyzing data from the day of NEC onset.

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“…Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease with high morbidity and mortality, affecting preterm infants, especially those with very low and extremely low birth weight [ 1 , 2 ]. NEC is characterized by acute intestinal ischemia and necrosis and a mortality of approximately 25% in most cases; however, in the most severe cases, it can reach as high as 80% in 48 h after diagnosis [ 3 ]. At present, therapies for NEC are limited to cessation of feeding, hemodynamic resuscitation and the administration of broad-spectrum antibiotics [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…β-glucan is a kind of bioactive polysaccharide obtained from yeast, mushrooms, algae, and cereals, such as oat β-glucan and Lentinus edodes β-glucan, which is believed to be beneficial for health and is edible to be taken orally as food supplements and daily diet [14][15][16][17]. It consists of β-D-glucose monomeric units linked together by glycosidic bonds at different positions, e.g., (1,3), (1,4), or (1,6). β-glucans and β-1, 3-D-glucans as well as β-1, 6-D-glucans derived from higher fungi, mushrooms, molds, and yeasts differ from β-1, 3-D-glucans and β-1, 4-D-glucans, which are primarily obtained from the cell walls and the seeds of some cereals [18].…”

Section: Introductionmentioning

confidence: 99%

β-glucan protects against necrotizing enterocolitis in mice by inhibiting intestinal inflammation, improving the gut barrier, and modulating gut microbiota

Zhang

et al. 2023

J Transl Med

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Background Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease with high morbidity and mortality, affecting preterm infants especially those with very low and extremely low birth weight. β-glucan has manifested multiple biological effects including anti-inflammatory, regulation of gut microbiota, and immunomodulatory activities. This study aimed to investigate the effects of β-glucan on NEC. Methods Neonatal C57BL/6 mice were randomly divided into three groups: Control group, NEC group and β-glucan group. Newborn 3-day-old mice were gavaged with either 1 mg/ml β-glucan or phosphate buffer saline at 0.03 ml/g for 7 consecutive days before NEC induction and a NEC model was established with hypoxia combined with cold exposure and formula feeding. All the pups were killed after 72-h modeling. Hematoxylin–eosin staining was performed to assess the pathological injury to the intestines. The mRNA expression levels of inflammatory factors in intestinal tissues were determined using quantitative real-time PCR. The protein levels of TLR4, NF-κB and tight junction proteins in intestinal tissues were evaluated using western blotting and immunohistochemistry. 16S rRNA sequencing was performed to determine the structure of the gut microbiota. Results β-glucan administration ameliorated intestinal injury of NEC mice; reduced the intestinal expression of TLR4, NF-κB, IL-1β, IL-6, and TNF-α; increased the intestinal expression of IL-10; and improved the expression of ZO-1, Occludin and Claudin-1 within the intestinal barrier. Pre-treatment with β-glucan also increased the proportion of Actinobacteria, Clostridium butyricum, Lactobacillus johnsonii, Lactobacillus murinus, and Lachnospiraceae bacterium mt14 and reduced the proportion of Klebsiella oxytoca g Klebsiella in the NEC model. Conclusion β-glucan intervention prevents against NEC in neonatal mice, possibly by suppressing the TLR4-NF-κB signaling pathway, improving intestinal barrier function, and partially regulating intestinal microbiota.

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Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis

Cited by 25 publications

References 38 publications

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

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

β-glucan protects against necrotizing enterocolitis in mice by inhibiting intestinal inflammation, improving the gut barrier, and modulating gut microbiota

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