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Published on: February 7, 2025
Acute drop in blood monocyte count differentiates NEC from other causes of feeding intolerance
J Remon1, R Kampanatkosol2, R R Kaul3
11] Division of Neonatology, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA [2] Center for Neonatal and Pediatric Gastrointestinal Disease, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.
Objective:
Necrotizing enterocolitis (NEC) is characterized by macrophage infiltration into affected tissues. Because intestinal macrophages are derived from recruitment and in situ differentiation of blood monocytes in the gut mucosa, we hypothesized that increased recruitment of monocytes to the intestine during NEC reduces the blood monocyte concentration and that this fall in blood monocytes can be a useful biomarker for NEC.
Study Design:
We reviewed medical records of very-low-birth-weight (VLBW) infants treated for NEC and compared them with a matched control group comprised of infants with feeding intolerance but no signs of NEC. Clinical characteristics and absolute monocyte counts (AMCs) were recorded. Diagnostic accuracy of AMC values was tested using receiver-operator characteristics (ROC).
Result:
We compared 69 cases and 257 controls (median 27 weeks, range 26 to 29 in both the groups). In stage II NEC, AMCs decreased from median 1.7 × 10(9) l(-1) (interquartile range (IQR) 0.98 to 2.4) to 0.8 (IQR 0.62 to 2.1); P < 0.05. In stage III NEC, monocyte counts decreased from median 2.1 × 10(9) l(-1) (IQR 0.1.5 to 3.2) to 0.8 (IQR 0.6 to 1.9); P < 0.05. There was no change in AMCs in control infants. ROC of AMC values showed a diagnostic accuracy (area under the curve) of 0.76. In a given infant with feeding intolerance, a drop in AMCs of > 20% indicated NEC with sensitivity of 0.70 (95% confidence interval (CI) 0.57 to 0.81) and specificity of 0.71 (95% CI 0.64 to 0.77).
Conclusion:
We have identified a fall in blood monocyte concentration as a novel biomarker for NEC in VLBW infants.
Insights
A drop in blood monocyte concentration can serve as a novel biomarker for necrotizing enterocolitis (NEC) in very-low-birth-weight (VLBW) infants. This finding offers a new diagnostic approach for this serious neonatal condition.
Area of Science:
- Neonatal Medicine
- Immunology
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a severe intestinal disease in premature infants.
- Macrophage infiltration is a key feature of NEC, with intestinal macrophages originating from blood monocytes.
- This study investigates the potential of blood monocyte levels as a biomarker for NEC.
Purpose of the Study:
- To test the hypothesis that increased monocyte recruitment to the gut in NEC leads to a decrease in blood monocyte concentration.
- To evaluate the diagnostic utility of blood monocyte counts for identifying NEC in very-low-birth-weight (VLBW) infants.
Main Methods:
- Retrospective review of medical records for VLBW infants diagnosed with NEC (cases) and matched controls with feeding intolerance but no NEC.
- Absolute monocyte counts (AMCs) were recorded and compared between groups.
- Diagnostic accuracy of AMCs was assessed using receiver-operator characteristic (ROC) analysis.
Main Results:
- AMCs were significantly lower in infants with stage II and III NEC compared to controls.
- A drop in AMCs of >20% showed a sensitivity of 0.70 and specificity of 0.71 for diagnosing NEC.
- ROC analysis indicated a diagnostic accuracy (area under the curve) of 0.76 for AMC values.
Conclusions:
- A decrease in blood monocyte concentration is a novel and potentially useful biomarker for NEC in VLBW infants.
- Monitoring AMCs may aid in the early detection and diagnosis of NEC.
- This finding contributes to understanding NEC pathogenesis and developing diagnostic tools.
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