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Age-adjusted eosinophilia in preterm infants with feeding intolerance: a retrospective cohort study
Ozge Serce Pehlevan1,2, Merve Cekildas3, Ayla Gunlemez4
1Department of Neonatology, Division of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey. ozge_serce@hotmail.com.
Insights
Peripheral eosinophilia is common in preterm infants with feeding intolerance (FI) and associated with more severe gastrointestinal issues. Eosinophil counts may aid in diagnosing complex cases of FI and necrotizing enterocolitis (NEC).
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Immunology
Background:
- Feeding intolerance (FI) presents diagnostic challenges in preterm infants due to nonspecific symptoms.
- Overlap with conditions like necrotizing enterocolitis (NEC) and cow's milk protein-related gastrointestinal disease complicates diagnosis.
Purpose of the Study:
- To investigate the association between peripheral eosinophilia and feeding intolerance (FI) in preterm infants.
- To explore the role of eosinophilia in necrotizing enterocolitis (NEC) and cow's milk protein-related gastrointestinal disease.
Main Methods:
- Retrospective cohort study of 122 preterm infants (<34 weeks gestation, <2000g) with high initial eosinophil counts.
- Infants were reclassified based on age-adjusted eosinophil reference values.
- Clinical features of FI, NEC, and cow's milk protein-related gastrointestinal disease were compared between infants with and without age-adjusted eosinophilia.
Main Results:
- Age-adjusted eosinophilia was present in 100 infants and significantly associated with FI (86% vs. 63.6%).
- Eosinophilic infants experienced longer feeding interruptions, more abdominal distension, and prolonged hospitalization.
- All 13 NEC cases occurred in eosinophilic infants; 11 infants with suspected cow's milk protein-related gastrointestinal disease improved with dietary changes.
Conclusions:
- Age-adjusted eosinophilia is frequently observed in preterm infants with FI and more severe GI manifestations.
- Eosinophilia may indicate an accompanying immune or inflammatory response rather than a direct cause of FI.
- Eosinophil counts can be supportive in managing persistent FI or NEC-like presentations, especially when considering other inflammatory GI processes.
Purpose:
Feeding intolerance (FI) remains diagnostically challenging because of nonspecific symptoms and overlap with multiple gastrointestinal conditions. This study investigated the association between peripheral eosinophilia and FI in preterm infants with exploratory evaluation of necrotizing enterocolitis (NEC) and cow's milk protein-related gastrointestinal disease in relation to eosinophilia.
Methods:
In this retrospective cohort study, 122 preterm infants (< 34 weeks' gestation, < 2000 g) with eosinophil counts ≥ 700/mm³ were included. Infants were subsequently reclassified according to gestational- and postnatal-age-adjusted eosinophil reference values. Clinical features of FI, NEC, and cow's milk protein-related gastrointestinal disease were compared between infants with and without age-adjusted eosinophilia. Multivariable logistic regression was used to explore clinical variables independently associated with feeding intolerance.
Results:
Age-adjusted eosinophilia was present in 100 infants. FI was more frequent in eosinophilic infants (86% vs. 63.6%, p = 0.027), with longer feeding interruption (median 2 vs. 0.5 days, p = 0.028), more abdominal distension (60% vs. 31.8%, p = 0.019), and prolonged hospitalization (60 vs. 41 days, p = 0.034). In the primary multivariable model, age-adjusted eosinophilia was independently associated with feeding intolerance (OR 6.00; 95% CI 1.32-27.26; p = 0.020), although the association was attenuated in sensitivity analysis (OR 2.87; 95% CI 0.86-9.58; p = 0.087). All 13 NEC cases occurred in eosinophilic infants, although the temporal relationship between eosinophilia and NEC varied. Suspected cow's milk protein-related gastrointestinal disease was identified in 11 infants, all of whom showed clinical improvement following dietary elimination.
Conclusions:
Age-adjusted eosinophilia was frequently observed in preterm infants with FI and more severe gastrointestinal manifestations. While unlikely to be causally related to FI, it may reflect an accompanying immune or inflammatory response during gastrointestinal disease. Eosinophil counts may provide supportive information in selected infants with persistent FI or NEC-like presentations, particularly when alternative inflammatory gastrointestinal processes are being considered.
