HYPONATREMIA, ACIDOSIS AND THROMBOCYTOPENIA LABORATORY INDICATORS FOR SURGERY IN NECROTISING ENTEROCOLITIS
Department of Preventive Medicine and Epidemiology, Pomeranian Medical University, Szczecin, Poland
OBJECTIVE: Necrotising enterocolitis (NEC) is the leading surgical cause of death in the neonatal period. Ethiology of that entity still remains unknown. Conservative treatment is considered as the best method of treatment in early NEC. However, surgical treatment is necessary in many cases but classical indications, like intestinal perforation or portal vein gas, are thought to be insufficient. The purpose of this study was to find which laboratory parameters could serve as simply available and reliable measures that indicate the need of surgery in these extremely sick neonates.
METHODS: Medical files of 125 newborns with different stages of NEC treated between 1990 and 1995 in Glasgow, Scotland (n=61) and Western Pomerania, Poland (n=64), were examined. The following parameters were studied: hematocrit, RBC, WBC, platelet count, ionogram including sodium. potassium and calcium levels, blood pH and base excess (BE). These findings were statistically evaluated and correlated with the methods of treatment (conservative versus surgical) and outcome in NEC children.
RESULTS: Fifteen (12%) of the studied NEC neonates were hyponatremic, fourteen of them were treated surgically and 10/15 died. Third stage of NEO was diagnosed in 13/15 of these patients, severe acidosis - in 11/15 and thrombocytopenia in 8/15, including 7 with platelet count < 100 x 103/ml. Hematocrit and RBC values were normal, and WBC, potassium and BE values turned out to be insignificant. Calcium levels were not available for all children and were excluded from the analysis.
CONCLUSIONS: Hyponatremia (<132 mmol/1), severe acidosis (especially pH< 7,25) and thrombocytopenia (<100 x 103/ml) turned out to be the indicators of clinical worsening in NEC neonates in that retrospective study. Early detection of changes within these parameters could accelerate the decision of surgical intervention before the clinical and radiological become clear enough. The results need further confirmation in the larger series of patients which would allow reliable statistical analysis.