Low serum albumin concentration predicts the need for surgical intervention in neonates with necrotizing enterocolitis
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In brief
In brief
Retrospective study of 151 neonates with NEC found that serum albumin ≤20 g/L on day 2 of diagnosis predicts need for surgical intervention with 71% positive predictive value. The 68 neonates requiring surgery showed sustained albumin decline versus medically managed cases, suggesting albumin may serve as a useful biomarker alongside clinical parameters for surgical decision-making in NEC Bell's stage 2.
Written by the GCMD Library team from the article.
Abstract
Purpose
To investigate whether serum albumin (SA) concentration can predict the need for surgical intervention in neonates with necrotizing enterocolitis (NEC).
Methods
Retrospective review of all cases with NEC Bell's stage 2 and 3 that were treated in a single center between 2009 and 2015. Data on patient demographics, clinical parameters, laboratory findings and surgical status were recorded. Receiver operating characteristics analysis was used to evaluate optimal cutoffs and predictive values.
Results
Overall, 151 neonates with NEC were identified. Of these, 132 (87.4%) had confirmed NEC Bell's stage 2. The median gestational age was 28.4 (range, 23.1–39.0) weeks and 69 (52.3%) had a birth weight of ≤1000 g. Sixty-eight (51.5%) underwent surgery, showing a sustained reduction in SA over time with significantly lower median SA levels compared to 64 (48.5%) cases that responded well to medical treatment (18.3 ± 3.7 g/L vs. 26.0 ± 2.0 g/L; P < 0.001). SA concentration of ≤20 g/L on day 2 of NEC diagnosis was a significant predictor for surgery (OR 3.41; P = 0.019) with a positive predictive value of 71.4%.
Conclusions
An SA concentration of ≤20 g/L on day 2 of the NEC disease process is associated with a higher likelihood for surgical intervention in neonates with NEC Bell's stage 2. SA, in combination with other clinical parameters and serological markers, may be a useful predictive tool for surgery in NEC.
Level of evidence
II