| ObjectiveNecrotizing enterocolitis(NEC)is a common and severe inflammatory disease of infants,which can lead to leave long-term intestinal sequelae even death,seriously affecting the prognosis of infants and causing a heavy economic burden.With the development of neonatal intensive care technology and the significantly increasing survival rate of premature infants,the morbidty and mortality of NEC remain high.This study compares the changes in blood cells among 6～24 hours after birth,6～8days after birth,and the onset of NEC,and explores the relationship between the changes of blood cells and the severity and prognosis of NEC in order to provide assistance for early identification of NEC,judgment of disease severity and prognosis.MethodsThis is a retrospective study of 118 infants with NEC admitted to the Neonatal Department of Guangzhou Women’s and Children’s Medical Center from January2017 to December 2022.Non-NEC infants were matched with the same gestational age(±2 weeks)and birth weight(±300g)as 1:2 ratio in the study period.Infants with NEC were divided into surgery group and non-sugery group,death group and survival group according to whether surgery,death or survival.We collected relevant data such as the general situation,clinical symptoms,hematological parameters at 6～24 hours after,6～8 days after birth,and the onset of NEC among the study subjects.The relationship between blood cytological changes and the severity and prognosis of NEC was analyzed by univariate analysis and multivariate logistic regression analysis.The predictive value of blood cytological changes on the occurrence and progression of NEC was analyzed by ROC curves.Result1.Analysis of risk factors that affect the occurrence of NEC: Multivariate logistic regression analysis showed that gestational diabetes(OR 1.849,95%CI 1.009～3.386),intrauterine distress(OR 2.591,95%CI 1.218～5.513),late onset sepsis(OR17.306,95%CI 6.746～44.393)were independent risk factors for NEC,while breast feeding(OR 0.390,95%CI 0.206～0.741)was independent protective factors for NEC.2.Analysis of risk factors that affect the outcome of NEC: Multivariate logistic regression analysis showed that low gestational age(OR 0.836,95%CI 0.708～0.986),late onset sepsis(OR 5.568,95%CI 1.201～25.816),hyperlactatemia(OR6.702,95%CI 1.193～37.651),and shock(OR 10.616,95%CI 1.157～97.406)were independent risk factors for NEC death.3.Analysis of changes in white blood cell parameters:The univariate analysis showed no statistically significant in white blood cell parameters between the groups within 6～24 hours after birth(P>0.05);In the 6～8 days after birth,the ANC,NLR,MLR,and N/PL in the NEC group were higher than those in the control group,while the ALC was lower than that in the control group.The PLR and N/PL in the surgical group were higher than those in the non-surgical group;When NEC occurred,the ALC and AMC in the NEC group,death group,and surgical group decreased,while NLR and N/PL increased,with statistically significant differences(P<0.05).Multivariate analysis showed that an increase in ANC at 6～8 days after birth was an independent risk factor for NEC(OR1.124,95% CI 1.049-1.204).ROC curve analysis showed that N/PL had the best predictive value for NEC at 6～8 days after birth(the cut-off value of 0.010,sensitivity of 96.5%,specificity of 90.6%),and N/PL had the best diagnostic and predictive value for the need for surgical intervention when NEC occurred(the cut-off value of 0.008,sensitivity of 54.2%,specificity of 89.4%;the cut-off value of 0.009,sensitivity of 85.4%,specificity of 70.0%).4.Analysis of changes in red blood cell parameters:The univariate analysis showed that the RBC of the NEC group and death group at 6～24 hours after birth was lower than that of the control group and survival group;In the 6～8 days after birth,the RBC,HGB,and HCT in the NEC group and death group were lower than those in the control group and survival group,while the RBC and HGB in the surgical group were lower than those in the non-surgical group;When NEC occurred,the RBC,HGB,and HCT in the NEC group,death group,and surgical group were lower than those in the control group,survival group,and non-surgical group;The △HGB and △HCT of the death group and the surgical group were higher than those of the survival group and the non-surgical group,with statistical significance(P<0.05).Multivariate analysis showed that low HCT at 6～8 days after birth(OR 0.940,95% CI 0.905-0.975;OR 0.848,95% CI 0.759-0.947)was an independent risk factor for NEC and mortality.5.Analysis of changes in platelet parameters:The univariate analysis showed that the PLT of the NEC group,death group,and surgical group at 6～24 hours after birth was lower than that of the control group,survival group,and non-surgical group;In the 6～8 days after birth,the PLT in the NEC group and surgical group was lower than that in the control group and non-surgical group,while the MPV and PDW in the surgical group were higher than those in the non-surgical group;When NEC occurred,the PLT of the NEC group,death group,and surgical group was lower than that of the control group,survival group,and non-surgical group.The MPV and PDW of the NEC group,death group,and surgical group were higher than those of the control group,survival group,and non-surgical,and the difference was statistically significant(P<0.05).The multivariate analysis showed that high MPV(OR 2.769,95% CI1.468-5.223)was an independent risk factor for NEC mortality,while high PDW(OR1.189,95% CI 1.004-1.408)was an independent risk factor for NEC surgery.ROC curve analysis showed that MPV had the highest predictive accuracy for NEC mortality when NEC occurred(the cut-off value of 13.05,sensitivity of 61.1%,specificity of 90.0%).Conclusion1.It is necessary to pay attention to these infants with gestational diabetes,intrauterine distress,premature and late onset sepsis after birth,and monitor NEC-infants with hyperlactatemia and shock.Infanhts should be advised on breast feeding.2.The changes of white blood cell is characterized by an increase in ANC and a decrease in ALC between 6 and 8 days after birth,and an increase in ANC is an independent risk factor for NEC.In the early stages of NEC,it is characterized by a decrease in ALC and AMC.Among the indicators derived from white blood cells,N/PL has the best predictive and diagnostic value for NEC.3.Severe anemia rather than blood transfusion,is associated with the occurrence of NEC.The severity and prognosis of NEC are related to the degree of anemia and whether blood transfusion is performed,but not to the frequency and timing of blood transfusion.Low HCT at 6～8 days after birth is an independent risk factor for NEC mortality.4.The platelet depletion occurs in the early postnatal period,and the increase in MPV and PDW has certain predictive value for whether surgical intervention is needed.The increase of MPV and PDW during NEC are risk factors for severe disease and poor prognosis. |
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