From the Guidelines
Laboratory Findings in Necrotizing Enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is characterized by distinct laboratory findings, including elevated white blood cell counts, often exceeding 20,000 cells/μL, and a left shift with increased immature forms 1. Blood cultures may be positive for enteric pathogens, and C-reactive protein levels are often elevated, exceeding 10 mg/dL. Additionally, abdominal radiographs may demonstrate pneumatosis intestinalis, portal venous gas, or free intraperitoneal air, which are diagnostic of NEC 2, 3.
Key Laboratory Features
- Elevated white blood cell counts (>20,000 cells/μL)
- Left shift with increased immature forms
- Positive blood cultures for enteric pathogens
- Elevated C-reactive protein levels (>10 mg/dL)
- Abdominal radiographs showing pneumatosis intestinalis, portal venous gas, or free intraperitoneal air
Laboratory Monitoring
Laboratory monitoring should include serial complete blood counts, blood gas analysis, and electrolyte panels to guide management 1. This monitoring is crucial for assessing the severity of NEC and guiding treatment decisions.
Diagnostic Criteria
The diagnostic criteria for NEC include the presence of fever, abdominal pain, and bowel wall thickening (>4 mm) on radiographic imaging 2, 3. These criteria help differentiate NEC from other abdominal conditions.
Management
Management of NEC may include broad-spectrum antibiotics, such as ampicillin and gentamicin, and supportive care, including hydration and pain management 1, 3. In severe cases, surgical intervention may be necessary.
From the Research
Laboratory Findings in Necrotizing Enterocolitis (NEC)
The laboratory findings in NEC include:
- Elevated C-reactive protein (CRP) levels, which can be used to diagnose and monitor the disease 4
- Abnormal blood culture results, which can indicate the presence of bacterial infection 4
- Elevated levels of acute phase proteins, inflammation mediators, and molecules involved in the immune response 5
- Presence of pneumatosis intestinalis, pneumoperitoneum, free peritoneal fluid, and portal venous gas, which can be detected using point-of-care ultrasound (PoCUS) 6
Biomarkers for NEC
Several biomarkers have been identified as potential predictors of NEC, including:
- Acute phase proteins 5
- Inflammation mediators 5
- Molecules involved in the immune response 5
- Emerging biomarkers detected using proteomics and metabolomics, such as those involved in the pathophysiological mechanisms underlying NEC 5
Imaging Modalities
Imaging modalities used to diagnose and monitor NEC include:
- Plain-film abdominal radiographs, which can detect pneumatosis intestinalis and pneumoperitoneum 7, 6
- Ultrasound (US), which can provide real-time imaging of abdominal structures and detect wall thickening, alteration of parietal echogenicity, and increase in wall perfusion 7, 6, 8
- Point-of-care ultrasound (PoCUS), which can be used to evaluate suspected NEC in the emergency department (ED) 6