Abstract: Objective To investigate the significance of different biomarkers in evaluating the necessity and the optimal time of operation for neonatal necrotizing enterocolitis (NEC). Methods A nest case control study was conducted, in which 68 neonates with NEC (NEC group) were divided into two groups, non-surgical group (n=33) and surgical group (n=35), another 42 healthy neonates without infectious disease were enrolled as control group. From the start of hospitalization, to surgery or death as the end point, 9 variables including procalcitonin (PCT), C-reactive protein (CRP), platelet (PLT), lactic acid (Lac), fibrinogen (Fib), albumin, white blood cell (WBC), pH and blood sugar were examined. Case control, univariate analysis, and logistic regression analysis were performed. OR and 95%CIwere calculated. Results Of the 68 patients with NEC, 35 (51.47%) required surgical treatment for digestive tract perforation (n=29), septic shock (n=5), and hepatic portal venous gas (n=1). The mortality was 17.65% (n=12). Case control study showed that PCT, CRP, platelet, lactic acid, albumin, WBC, pH and blood sugar of the NEC group were significantly different from those of the control group (P<0.05). Univariate analysis indicated that PCT, CRP, platelet, lactic acid and albumin were associated with surgical therapy (P<0.05). Logistic regression analysis showed that platelet and PCT were significantly relevant to surgical therapy (P<0.05). ROC curve showed the cut-off value of PCT was 3.32 ng/mL, sensitivity 71.40%, specificity 81.80%, positive predictive value 80.60% and negative predictive value 72.90%. Conclusion Serial changes in biomarkers may predict progression of NEC to surgery or death in neonates. Persistently low platelet count and significantly increased PCT value (≥3.32 ng/mL) indicated that the neonates with NEC required surgical treatment.

Key words: Biomarkers, Neonate, Procalcitonin, Surgery, Necrotizing enterocolitis