Analysis Of The Predictive Value Of SAA,NLR,CRP And PDW On The Timing Of Neonatal Necrotizing Enterocolitis Surgery

Background Necrotizing enterocolitis(NEC)is a common gastrointestinal-related disease that causes necrotizing enterocolitis perinatal mortality before 37 weeks of gestation.Conservative treatment is the main treatment for NEC.When the condition of NEC is serious,surgical treatment is needed.Appropriate timing of surgical treatment can improve the prognosis of NEC.NEC surgery is an absolute indication of intestinal perforation,but when intestinal perforation is confirmed by imaging examination,it indicates that the patient is in a critical condition and the prognosis of surgical treatment is poor,therefore,it is very important to choose the appropriate operation time when NEC children appear relative operation indication.Previous literature suggested that the best time to operate is when large area of intestinal necrosis is about to occur but no perforation has occurred,but there are not many indicators to predict the timing of neonatal necrotizing enterocolitis surgery.Studies have shown that the occurrence and development of NEC in neonates are related to inflammatory reaction and platelet activation.Serum Amyloid A(SAA)and C-reactive protein(CRP)are common Acute phase reaction protein in clinic,which are related to the severity of NEC.In recent years,researchers have found that the neutrophil lymphocyte ratio(NLR)can also reflect the degree of inflammation.It has been reported that NLR is an inflammatory index reflecting the degree of inflammation in NEC.In addition platelet distribution width(PDW)has been reported to be correlated with the occurrence and development of NEC.However,the relationship between serum SAA,NLR,CRP,PDW and the timing of NEC surgery is less reported,the purpose of this study was to investigate the relationship between serum SAA,CRP,PDW and NLR levels and the timing of operation in children with NEC,the aim of this study is to provide some theoretical guidance for the choice of Operation Timing in NEC.Objective It was designed to investigate the predictive value of SAA,CRP,PDWand NLR for the timing of neonatal necrotizing enterocolitis(NEC)surgery.Methods A total of 82 children with confirmed NEC admitted to Foshan Maternal and Child Health Hospital from January 2019 to January 2022 were selected as the study subjects,12 cases were excluded due to intraoperative intestinal perforation,congenital megacolon and other factors,and 70 children were finally included in the study,,and they were divided into sugery group with 35 cases and non-surgery group with 35 cases according to treatment methods.Clinical data of children with NEC were collected,and the levels of serum SAA,CRP,peripheral blood PDW and NLR in the two groups were detected.Univariate and multivariate Logistic regression were used to analyze the influencing factors of neonatal NEC surgery.The predictive value of serum SAA,CRP,peripheral blood PDW and NLR on the timing of neonatal NEC surgery was analyzed by receiver operating characteristic(ROC)curve.Results1.The gestational age greater than or equal to 37 weeks and the proportion of weight at diagnosis greater than 2500g in the surgery group were lower than those in the non-surgery group,which was significantly different(P<0.05).2.The rate of weight 1500-2500g,poor mental reaction,abdominal distention and weak bowel sounds(<4 times/min)in the operation group was higher than that in the non-operation group,which was significantly different(P<0.05).3.The levels of serum SAA,CRP,peripheral blood PDW and NLR were higher than those in the non-surgery group,which was significantly different(P<0.05).4.Multivariate Logistic regression analysis showed that weight at diagnosis greater than 2500g was an independent protective factor for neonatal NEC surgery,poor mental response,abdominal distension,weak bowel sound(<4times/min)and increased levels of serum S AA,CRP,PDW and NLR were independent risk factors for neonatal NEC surgery,which was significantly different(P<0.05).5.The ROC curve analysis showed that the cutoff values of SAA,CRP,PDW and NLR were 19.25 mg/L,16.58 mg/L,17 fL and 8.03,The AUC was used to predict the timing of NEC was 0.784,0.781,0.787,0.801,The AUC of serum SAA,CRP,PDW and NLR was 0.974.6.The ROC curve analysis showed that the area under the curve(AUC)of serum SAA,CRP,peripheral blood PDW and NLR combined to predict the timing of neonatal NEC surgery was greater than that of each index alone.Conclusions1.Compared with the surgical group,the proportion of the 35 children with NEC weighing weight at diagnosis was more important in the non-surgical group High,less likely to have poor mental response,abdominal distension,weak bowel sounds(<4 beats/min)and increased serum SAA,CRP,peripheral PDW and NLR levels.2.Poor mental response,abdominal distension,weak bowel sounds(<4 times/min)and increased serum SAA,CRP,peripheral PDW and NLR levels were independent risk factors for neonatal NEC surgery.3.Elevated serum SAA,CRP,peripheral PDW and NLR levels were closely related to neonatal NEC surgery,and the value of the four indicators combined to predict the timing of neonatal NEC surgery was greater than that of each index alone.