Analysis of Early Surgical Indications and Related Factors in Neonatal Necrotizing Enterocolitis

Xianhui Shang^1,2Huinan Wang³Yuanmei Liu^1,2*Xuefeng Yang⁴Huang Lu^1,2Hao Fu^1,2Luping Xiang^1,2Shiyu Xu^1,2

• ¹Affiliated Hospital of Zunyi Medical University, Zunyi, China
• ²Guizhou Children's Hospital, Zunyi, Guizhou Province, China
• ³Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China
• ⁴Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China

Objective: To explore early surgical indications and clinical predictive factors for neonatal necrotizing enterocolitis (NEC) to improve the prognosis of affected infants.Methods: A retrospective analysis was conducted on the clinical data of 146 infants diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2015 to December 2020. The infants were divided into two groups: the surgical treatment group (56 cases) and the non-surgical treatment group (90 cases).Maternal perinatal conditions, general infant characteristics, clinical manifestations, comorbidities, laboratory tests, and imaging findings were statistically analyzed.Significant factors were further analyzed using multivariate logistic regression, and predictive indicators were assessed by the receiver operating characteristic (ROC) curve and Youden's index.Results: Statistically significant differences were observed between the two groups in birth weight, gestational age, abdominal wall erythema, absent bowel sounds, lethargy, fever, peritonitis, septic shock, metabolic acidosis, neonatal acute respiratory distress syndrome, and asphyxia (P<0.05). No significant differences were found in maternal perinatal conditions, sex, feeding method, age at onset, abdominal distention, bloody stool, vomiting, gastric retention, apnea, neonatal pneumonia, neonatal hyperbilirubinemia, sepsis, electrolyte disturbances, or respiratory failure (P>0.05). Laboratory and imaging markers such as prealbumin, IL-6, PCT, CRP, WBC, pneumoperitoneum, bowel wall gas, and portal venous gas showed statistically significant differences (P<0.05). Multivariate logistic regression identified peritonitis (OR=95.635), IL-6 (OR=1.001), and portal venous gas (OR=22.551) as independent risk factors for early surgery in NEC (P<0.05). ROC curve analysis revealed that IL-6 (AUC=0.875) and PCT (AUC=0.798) demonstrated good predictive performance for early surgical intervention. The optimal cutoff values were 476 pg/mL for IL-6 (sensitivity 80.4%, specificity 85.6%) and 1.53 ng/mL for PCT (sensitivity 83.9%, specificity 70%).Peritonitis and portal venous gas are independent risk factors for early surgery in NEC. IL-6 and PCT are reliable predictive markers for determining the need for early surgical intervention in NEC.