Predictors of Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

Abstract

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates with high death and morbidity.

Aim: This study aimed to recognize demographic, laboratory, and clinical predictors related to the need for surgical management in neonates with NEC.

Methods: This retrospective observational study was conducted on 200 patients over a three-year period in a tertiary neonatal intensive care unit. Neonates diagnosed with NEC (Bell’s stage II or III) were included and divided into surgical and conservative management groups.

Results: A total of 200 neonates with NEC have been involved; 45 required surgical intervention, and 155 were managed conservatively. Neonates in the surgical group had significantly lower gestational age and birth weight (p under 0.001). Severe clinical features, including abdominal distension, abdominal rigidity, weak bowel sounds, poor mental reaction, tachycardia, and advanced Bell’s stage, were significantly more prevalent in the surgical group (p below 0.05). Multivariate analysis recognized CRP and lactate as independent predictors of surgical intervention, while higher gestational age, absolute lymphocyte count, and white blood cell count were protective. ROC analysis showed good predictive accuracy for CRP (AUC = 0.792).

Conclusion: Prematurity, low birth weight, severe clinical presentation, and elevated inflammatory and metabolic markers are strongly associated with surgical NEC. CRP, in particular, is a reliable predictor and can aid in early recognition of high-risk neonates, facilitating timely surgical decision-making and improved outcomes.