Platelets and Immature Neutrophils in Preterm Infants with Feeding Intolerance

Abstract

Objective Feeding intolerance (FI) is a common presentation of necrotizing enterocolitis (NEC) and sepsis. NEC and sepsis are associated with hematological changes, but these changes alone are not reliable biomarkers for early diagnosis. This study examined whether the combination of hematological indices and FI can be used as an early diagnostic tool for NEC or sepsis. Study Design This retrospective cohort study included infants born at <1,500 g or <30 weeks who had symptoms of FI. The exclusion criteria were congenital or chromosomal disorders, thrombocytopenia or platelet transfusion before the onset of FI, and history of bowel resection. We compared the hematological indices from infants with pathologic FI (due to NEC or sepsis) to infants with benign FI. Results During the study period, 211 infants developed FI; 185 met the inclusion criteria. Infants with pathologic FI (n = 90, 37 cases with NEC and 53 with sepsis) had lower birth gestational age and weight compared with 95 infants with benign FI (n = 95). Pathologic FI was associated with lower platelet count (median 152 × 103/μL vs. 285 × 103/μL, p < 0.001) and higher immature-to-total neutrophil (I/T) ratio (median 0.23 vs. 0.04, p < 0.001) at the onset of FI. Pathologic FI was also associated with a decrease in baseline platelets compared with an increase in benign FI. For diagnosis of pathologic FI, a decrease ≥10% in platelets from baseline had a sensitivity and specificity of 0.64 and 0.73, respectively, I/T ratio ≥0.1 had a sensitivity and specificity of 0.71 and 0.78, respectively, and the combination of both parameters had a sensitivity and specificity of 0.50 and 0.97, respectively. Conclusion FI caused by NEC or sepsis was associated with a decrease in platelets from baseline, and a lower platelet level and higher I/T ratio at the onset of FI. These findings can help clinicians in the management of preterm infants with FI. Key Points

Risk Factors Affecting Length of Stay in Preterm Infants at Wangaya Regional General Hospital, Indonesia

“…16 Feeding intolerance is often associated with NEC and sepsis and with hematological changes, such as a decrease in platelet count and an increase in the ratio of immature neutrophils to total neutrophils (I/T ratio). 17 The gut microbiome has also been implicated in feeding intolerance, with differences in gut flora composition observed between infants with feeding intolerance and those with feeding tolerance. 18 Several studies have reported that preterm infants with food intolerance have a longer hospital stay.…”

Analysis on the Application Effect of Abdominal Acupoint Massage on Feeding Intolerance in Premature Infants

“…Intolerance occurs because the functions of various organs have not fully developed in newborn infants, who cannot digest food in a timely manner after feeding. In general, the best food for newborn infants is breast milk, but feeding intolerance often occurs when some parturients cannot provide breast milk for some reasons such as breast milk insufficiency or suffering from infectious diseases [ 18 – 21 ]. In addition, compared with the fetuses delivered at term, premature infants have more incomplete development of various functions and a larger incidence of feeding intolerance.…”

Application Effect of Acupoint Massage on Zusanli on Premature Infants with Feeding Intolerance and Their Clinical Symptoms

“…Besides, in some cases, mental retardation also affects premature infants, further increasing the probability of death. erefore, the academic community should pay more attention to further exploring the clinical symptoms of premature infants with FI to provide solid theoretical support for the selection of suitable treatment and drugs [4][5][6][7]. At present, erythromycin is the main drug for the treatment of FI in clinical practice, whose mechanism is to enhance gastrointestinal motility and subsequently relieve the symptoms of FI in affected infants; however, this drug can also increase the incidence of abdominal pain and abdominal distension, so combination therapy should be implemented to improve treatment effect of FI.…”