Is the absolute lymphocyte count a biomarker for neonates with necrotizing enterocolitis needs surgical consultation?

Abstract Background: Previous studies reported contradicting results about the association between the absolute lymphocyte count and necrotizing enterocolitis. The aim of this study was to explore whether the absolute lymphocyte count of (ALC) can be a biomarker for neonates with necrotizing enterocolitis needs surgical consultation. Methods: We retrospectively analyzed perinatal data, clinical features before NEC onset (T0), laboratory values at T0 and at the time within the 24h after NEC onset(T1) from neonates with confirmed NEC who were admitted to Guangzhou Women and Children’s Medical Center from January 2016 to June 2021. Univariate and multivariate logistic regression analyses were used to evaluate predictive factors of surgical NEC. Receiver operating characteristics analysis was used to evaluate cutoffs and predictive values. Results: Overall, 224 neonates with NEC were identified, including 80 cases (35.7%) underwent surgical intervention (surgical NEC) and 144 cases (64.3%) were managed with conservative treatment (medical NEC). Multivariate Logistic regression analysis showed that male gender [p value, adjusted odds ratio [95%CI]; 0.002, 3.36(1.53-7.35)], low ALC on T1[(<0.001, 0.37(0.25-0.55)] were identified as independent risk factors for surgical NEC. The area under curve (AUC) of ALC on T1 was 0.814 (95% CI 0.757~0.871). The optimal cut-off value was 2.10*109/L with 80% sensitivity and 74% specificity. Conclusion: In neonates with NEC, low ALC may indicate a higher probability of needing surgical intervention. Timey surgical consultation may assist in the early diagnosis of the surgical NEC and avoid missing the optimal timing of surgery.