Prediction of progression of definite necrotising enterocolitis to need for surgery or death in preterm neonates

Abstract

Objective. To study the predictive abilities of laboratory parameters in the prediction of progression of definite necrotising enterocolitis (NEC) to need for surgery or death in preterm neonates.Methods. Retrospective analysis of data (January 2001–July 2006) on all preterm (gestation < 32 weeks) neonates with definite (Stage ≥ II) NEC according to the Bell's staging in a regional referral centre. Group I included those who were medically managed (medical NEC) and Group II requiring surgery (surgical NEC). Serial changes in laboratory parameters (C-reactive protein, (CRP), platelet count, plasma glucose and lactate) within 24 h before and over 72 h after the diagnosis of NEC were correlated to progression to surgery or death.Results. CRP levels were significantly higher at 72 h in the surgical versus medical group. Plasma glucose and lactate levels were significantly higher when compared with the baseline levels at all time points for both groups. Receiver operator curve analysis (N = 30) indicated that significant rise in CRP [baseline to 72 h (area under the curve, AUC: 0.933, p = 0.001)] and in lactate levels [baseline to 48 h (AUC: 0.818, p = 0.047)] had a strong potential as a predictor for progression to surgery or death.Conclusion. Serial changes in CRP and plasma lactate level may predict progression of definite NEC to surgery or death in preterm neonates.