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A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis
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Hematologic Inflammatory Indices Predict Mortality in Surgical Necrotizing Enterocolitis Among Premature Infants
Ahmet Dursun1, İpek Kocaoğlu2, Tülin Öztaş3
1Department of Pediatric Surgery, Faculty of Medicine, Mugla Sıtkı Kocman University, 48000 Mugla, Turkey.
Children (Basel, Switzerland)
|February 27, 2026
Summary
A postoperative drop in platelet-to-neutrophil ratio (PNR) can help identify premature infants at high risk of death from necrotizing enterocolitis (NEC) after surgery. This simple blood test aids early risk stratification.
Area of Science:
- Neonatal surgery
- Pediatric critical care
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in premature infants, with high mortality, especially after surgery.
- Early identification of high-risk neonates with NEC remains a clinical challenge.
Purpose of the Study:
- To assess the prognostic capability of complete blood count-derived inflammatory indices for predicting mortality in premature infants undergoing surgery for NEC.
- To identify reliable hematologic biomarkers for early risk stratification in surgical NEC cases.
Main Methods:
- Retrospective analysis of 74 premature neonates with Bell stage II or III NEC who underwent surgery.
- Recorded preoperative and postoperative hematologic inflammatory indices: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and platelet-to-neutrophil ratio (PNR).
- Utilized Receiver Operating Characteristic (ROC) curve analysis and multivariate logistic regression for predictive performance assessment.
Main Results:
- Overall mortality was 35.1%; non-survivors had lower gestational age, birth weight, and more advanced NEC.
- Preoperatively, non-survivors showed higher NLR and lower PNR. Postoperatively, NLR and C-reactive protein increased, while PNR declined significantly in non-survivors.
- Postoperative PNR was the strongest mortality predictor, followed by preoperative SII and postoperative NLR. Reduced postoperative PNR independently predicted mortality.
Conclusions:
- A postoperative decrease in platelet-to-neutrophil ratio (PNR) is a practical, inexpensive biomarker for risk stratification in surgically treated NEC.
- Routine monitoring of hematologic inflammatory indices can aid in timely identification of high-risk infants, guiding individualized care in neonatal intensive care units.
