NECROTIZING ENTEROCOLITIS - LABORATORY INDICATORS OF SURGICAL DISEASE

The timely distinction between infants with necrotizing enterocolitis (NEC) who need surgery and those who are likely to recover with medica l management is important, but it may be difficult clinically. Because pneumoperitoneum is not always present, additional markers of bowel g angrene are needed. Among 73 babies managed for NEC over the study per iod, 49 (67%) met the study criteria of Bell's stage > 1, and their re cords were reviewed to determine the usefulness of common laboratory t ests in predicting outcome. The patients were divided into three group s based on management. Group 1 (7 patients) required surgery at the ti me of initial presentation because of pneumoperitoneum. The remaining 42 patients were initially managed medically, 19 of whom (group 2) rec overed successfully; the other 23 (group 3) required surgery. The comb ination of certain laboratory tests, ie, white blood cell count (WBC), immature:total neutrophil ratio (I:T), platelet count (PLT), and base excess (BE), was of significance in distinguishing between infants wh o would need surgery and those who would recover with medical therapy (group 3 v group 2) 4 to 12 hours or 12 to 24 hours after the diagnosi s of NEC was established. A scoring scale was developed, with a point for each of the following: WBC < 9,000/mm(3), I:T > .5, PLT < 200,000/ mm(3), and BE less than or equal to -2. A score of greater than or equ al to 3 during 4 to 12 hours after diagnosis of NEC strongly predicted the presence of surgical disease (positive predictive value, 100%; ne gative predictive value, 76%; specificity, 100%; sensitivity, 64%). Th is scoring scale, along with clinical course, can assist in determinin g the need for surgery in a timely manner. Copyright (C) 1994 by W.B. Saunders Company