Gestational Age-Specific Complete Blood Count Signatures in Necrotizing Enterocolitis.

Julia M Pantalone,Misty Good,Justin R Buland,Erica C Prochaska,Oluwabunmi O Olaloye,Beverly S Brozanski,Silvia Liu,Melissa M Riley,Toby Yanowitz,Liza Konnikova

doi:10.3389/fped.2021.604899

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.

Highlights

Necrotizing enterocolitis (NEC) is a neonatal gastrointestinal emergency with significant morbidity and mortality [1]
At NEC onset, there was an acute drop in monocytes and lymphocytes along with a rise in bands in S-NEC infants born
We identified two discrete immune patterns in NEC based on gestational age (GA)

Summary

Introduction

Necrotizing enterocolitis (NEC) is a neonatal gastrointestinal emergency with significant morbidity and mortality [1]. NEC most likely encompasses a spectrum of different pathologies that present and must be contextualized based on infants’ individual risk factors [2, 3]. Circulating immune cells likely contribute to illness progression and may be helpful biomarkers in diagnosing infants suspected of having NEC and/or stratifying disease severity. Neutropenia at illness onset is seen in severe NEC and is associated with greater extent of disease and surgical intervention [6,7,8]. A number of studies have suggested that alterations in lymphocytes are associated with NEC, the data are mixed [9,10,11]. Some studies report that lymphocytosis is associated with worse outcomes [9, 10], while others show that lymphopenia is correlated with mortality in NEC [11]

Methods

Results

Discussion

Conclusion