Low serum albumin concentration predicts the need for surgical intervention in neonates with necrotising enterocolitis

1. Among infants with necrotizing enterocolitis, serum albumin ≤ 20 g/L was associated with a significantly greater likelihood of requiring surgical intervention.

Evidence Level Rating: 2 (Good)

Necrotizing enterocolitis (NEC) is the most common emergent condition affecting the gastrointestinal tract of neonates, and predominantly prevalent in premature and low birth weight infants during the first week of life. Mortality is high, between 12 and 32%, especially among infants requiring surgical intervention. The purpose of this retrospective cohort study was to evaluate the predictive role of serum albumin (SA) in identifying neonates with NEC that eventually went on to require surgery. 151 infants (median [range] age = 28.2 [23.1-39.0] weeks, 57% male) with confirmed NEC were identified. 132 infants had NEC Bell’s stage 2, while 19 had NEC Bell’s stage 3. Among NEC Bell’s stage 2 infants, 64.7% ultimately required surgical intervention. SA ≤ 20 g/L (or 2 g/dL) at day one of diagnosis was associated with a higher risk of needing surgery (OR 4.32, 95% CI 1.50 to 12.46, p = 0.007), with an increasing likelihood seen at day two (OR 3.44, 95% CI 1.53 to 7.71, p = 0.003). Other risk factors – including male sex, gestational age ≤ 28 weeks, and birth weight ≤ 1000 g – were also associated with the need for surgery, but only SA ≤ 20 g/L on day two of diagnosis remained significant after multivariate analysis, with an aOR of 3.14 (p = 0.019). ROC curve analysis revealed that SA ≤ 20 g/L at day two of diagnosis had a sensitivity of 41.0% and a specificity of 83.3% in predicting the need for future surgical intervention in neonates with NEC Bell’s stage 2. The positive and negative predictive values were 71.4% and 58.1%, respectively. In all, this study suggested that SA level is a useful biomarker for the severity of NEC among infants that predicts the need for future surgical intervention and may be a tool clinicians can use to risk stratify patients.

Click to read the study in the Journal of Pediatric Surgery

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