Hematologic Inflammatory Indices Predict Mortality in Surgical Necrotizing Enterocolitis Among Premature Infants

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in premature neonates, with particularly high mortality among those requiring surgical intervention. Early identification of high-risk patients remains challenging. This study aimed to evaluate the prognostic value of complete blood count-derived inflammatory indices for predicting mortality in premature infants undergoing surgery for NEC. Methods: A total of 74 premature neonates with Bell stage II or III NEC who underwent surgical treatment between 2018 and 2023 were retrospectively analyzed. Preoperative and postoperative hematologic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and platelet-to-neutrophil ratio (PNR), were recorded. Receiver operating characteristic (ROC) curve analysis was used to assess predictive performance. Variables with p < 0.10 in univariate analysis were entered into multivariate logistic regression models. Results: Overall mortality was 35.1%. Non-survivors had significantly lower gestational age and birth weight and a higher prevalence of advanced disease. Preoperatively, NLR was higher and PNR was lower in non-survivors. Postoperatively, NLR and C-reactive protein levels increased, while PNR showed a marked decline in infants who died. ROC analysis identified postoperative PNR as the strongest predictor of mortality, followed by preoperative SII and postoperative NLR. Multivariate analysis demonstrated that lower gestational age, advanced disease stage, and reduced postoperative PNR were independently associated factors for mortality. Conclusions: Postoperative reduction in platelet-to-neutrophil ratio appears to be a practical, inexpensive, and easily obtainable biomarker for early risk stratification in surgically treated NEC. Incorporating routine hematologic inflammatory indices into postoperative monitoring may support timely identification of high-risk infants and guide individualized clinical management in neonatal intensive care units.