The Value Of Abdominal Signs Combined With Fecal Biomarkers In Decision-making Of Operation Timing For Necrotizing Enterocolitis

Objective: Necrotizing enterocolitis(NEC)is a serious intestinal inflammatory disease in the neonatal period.Surgical intervention is often needed in severe cases,so it is particularly important to confirm the surgical guidelines in time.The purpose of this study was to investigate the value of abdominal signs combined with intestinal epithelial injury biomarkers including Claudins-3,high mobility group box 1(HMGB1)and Human β defensin 2(HBD 2)in decision-making of NEC operation timing.Methods: The infants diagnosed as NEC(Bell’s stage≥II)who were treated in our hospital from March 2019 to November 2020 were enrolled.The infants were divided into non-operation group and operation group and their baseline information,abdominal signs and imaging examination were collected.Fecal samples were collected on the day of NEC diagnosis in the non-operation group and the day of operation in the operation group.The protein concentrations of Claudins-3,HMGB1 and HBD2 in feces were determined by enzyme linked immunosorbent assay(ELISA).Receiver operating characteristic curve(ROC)was established and area under the curve(AUC)was calculated to analyze the value of abdominal signs and fecal biomarkers in decision-making of NEC operation timing.Results: During the study period,69 infants(27 cases in the operation group and 42 cases in the non-operation group)were included in this study.The incidence of abdominal wall redness,abdominal fixation tenderness and abdominal muscle tension in the operation group was higher than that in the non-operation group(P<0.05).AUC of abdominal wall redness,abdominal fixation tenderness and abdominal muscle tension were 0.636,0.794 and 0.873 respectively.The protein concentrations of Claudins-3,HMGB1 and HBD2 in the feces of the operation group were higher than those of the non-operation group(P<0.05).AUC of Claudins-3,HMGB1 and HBD2 were 0.759,0.637 and 0.646 respectively.The AUC of abdominal muscle tension combined with fecal Claudins-3 was 0.913 in the decision-making operation timing for NEC.Meanwhile,the AUC of Claudins-3 combined with other abdominal signs in determining the operation timing for NEC was between 0.779 and 0.939.Conclusions: Abdominal signs combined with fecal biomarker Claudins-3 have high value in decision-making of operation timing for NEC.