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Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis

Journal of Perinatology volume 41, pages 1110–1121 (2021)Cite this article

Subjects

Abstract

Objective

Determine whether hematological and transfusion patterns following, the onset of NEC can identify infants likely to develop fulminant, fatal necrotizing enterocolitis (NEC).

Design

Determine hematological predictors of fulminant NEC.

Results

Of 336 neonates with NEC, 35 (10%) who developed fulminant NEC were born with higher birth weights and more frequently developed radiologically evident pneumoperitoneumand/or portal venous gas. Following the diagnosis of NEC, these infants were more likely to rapidly develop thrombocytopenia, lymphopenia, neutropenia, and lower total white blood cell counts compared to medical/surgical non-fulminant type. They were also more likely to have received a red blood cell (RBC) transfusion (76.7% vs. 53.1%, p = 0.001) within 48 h after disease onset and platelet transfusion (24.2% vs. 11.7%; p = 0.03) before the onset of NEC.

Conclusion

Neonates with fulminant NEC frequently developed thrombocytopenia, lymphopenia, neutropenia, and leukopenia, received RBC transfusions after or platelet transfusions before the onset of NEC developed the fulminant disease.

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Fig. 1: Kaplan–Meier curve (survival curve) showing mortality in neonates with fulminant necrotizing enterocolitis.
Fig. 2: Heamatological changes before and seven days after NEC onset.

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Acknowledgements

We would like to thank Dr Robert Christensen (Professor and Division Chief of Neonatology at Intermountain Medical Center, Utah), Dr Akhil Maheshwari (Professor, Department of Pediatrics/Neonatology at John Hopkins Hospital, Baltimore), and Dr Martha C. Sola-Visner (Department of Neonatology, Boston Children Hospital, and Boston, Massachusetts) for critically reviewing the manuscript and providing for all the feedback and guidance.

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Authors and Affiliations

  1. Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, MS, USA

    Parvesh Mohan Garg, Anna O’Connor, Binh Vu, Haley Hobart, Jaslyn L. Paschal & Harleen Multani

  2. Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA

    Md Abu Yusuf Ansari & Victoria Okhomina

  3. Department of Pathology, Emory Center for Transfusion and Cellular Therapies, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Cassandra D. Josephson

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  1. Parvesh Mohan Garg
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Contributions

PMG designed the study. PMG, VO, AC, BV, HH, HM, JLP, MAYA, CDJ collected and analyzed the data. PMG, MAYA wrote the manuscript. All the authors contributed to and approved the manuscript.

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Correspondence to Parvesh Mohan Garg.

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Garg, P.M., O’Connor, A., Ansari, M.A.Y. et al. Hematological predictors of mortality in neonates with fulminant necrotizing enterocolitis. J Perinatol 41, 1110–1121 (2021). https://doi.org/10.1038/s41372-021-01044-3

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