Combination of plasma white blood cell count, platelet count and C-reactive protein level for identifying surgical necrotizing enterocolitis in preterm infants without pneumoperitoneum

Purpose To evaluate whether plasma white blood cell count (WBC), platelet count (PLT), and C-reactive protein level (CRP) can be used to differentiate surgical necrotizing enterocolitis (NEC) from medical NEC. Methods Preterm infants admitted between January 1, 2011 and July 31, 2015 were stratified by the need of surgery as surgical NEC ( n = 41) and medical NEC ( n = 43). The values of WBC, PLT and CRP were collected at time before NEC occurred ( T 0 ), at onset of NEC ( T 1 ) and when surgical assessment was required ( T 2 ). Patients admitted between August 1, 2015 and March 1, 2018 ( n = 53) were collected for further verification. Results Variables identified in logistic regression analysis predicting surgical NEC were WBC and PLT at T 2 (WBC 2 and PLT 2 ). The predictive probability of surgery ( P ) could be calculated by the equation ln ( P / ( 1 - P ) ) = 2.801 - 0.207 WB C 2 - 0.008 PL T 2 . The area under curve of P was 0.84 and the ideal cutoff value was 0.55, with sensitivity and specificity of 85 and 81%, respectively. This cutoff value got an sensitivity of 80% and specificity of 79% in the verification group. Conclusion Combination of WBC and PLT can effectively differentiate surgical NEC from medical NEC infants when surgical assessment was required.