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Elevated day-2 hemoglobin P₅₀ and risk of necrotizing enterocolitis in preterm infants: a pilot study
Yakup Karakurt1, Çağrı Cumhur Gök1, Emrah Can2
1Department of Pediatrics, Bağcılar Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye.
Purpose:
To evaluate whether hemoglobin P₅₀, automatically calculated from routine blood gas analyses, can serve as a practical early biomarker for necrotizing enterocolitis (NEC) in preterm infants.
Methods:
We retrospectively analyzed 117 preterm infants born at < 32 weeks' gestation who were admitted to a tertiary NICU between 2022 and 2024. Hemoglobin P₅₀ and serum lactate values were obtained from arterial blood gases on postnatal days 1-3. NEC was defined according to modified Bell's criteria (stage ≥ II). Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, with a prespecified P₅₀ threshold of 21.0 mmHg.
Results:
NEC developed in 27 infants (23%). Mean day-2 P₅₀ was significantly higher in the NEC group compared with controls (22.5 ± 6.8 vs. 18.9 ± 3.6 mmHg; p = 0.03). Day-2 P₅₀ predicted NEC with moderate accuracy (AUC 0.70, 95% CI 0.56-0.83), outperforming lactate (AUC 0.52, 95% CI 0.38-0.67). At the 21.0 mmHg cutoff, sensitivity was 67%, specificity 72%, positive predictive value 41.8%, and negative predictive value 87.9%.
Conclusion:
Day-2 hemoglobin P₅₀ was elevated in infants who subsequently developed NEC. These preliminary findings indicate that P₅₀ may be a feasible, cost-effective biomarker for early NEC risk stratification; however, larger prospective studies are required to validate its predictive utility.
