Decrease in absolute monocyte count as a predictor of NEC in preterm neonates with gestational age <32 weeks

AMC as a promising biomarker in NEC

Abstract

Background: Necrotizing enterocolitis (NEC), an inflammatory bowel disorder with definite reason of the disease still unclear and a varied number of differential factors postulated for contributing towards the disease. With radiological findings providing limited degree of assessment that too at advanced stage of the disease, a need is felt in devising criteria to detect NEC in its early stage.

Objective: To study decrease in absolute monocyte count as a predictor of NEC in preterm neonates with gestational age <32 weeks.

Participants and Study design: A prospective case control study enrolling a total of 60 preterm neonates who on the basis of BELL’s classification were categorized as NEC and Advanced NEC while as those who exhibited no relevant signs were categorized as controls.

Method: All base line investigations including CBC for monocyte count were done at the time of admission. CBC for monocyte count were repeated on day 1, day 7, day 14 and on day 28 of life or at any time of clinical deterioration. NEC was diagnosed on the basis of clinical features. The clinical features of NEC were divided into systemic and abdominal signs.

Results: In a total of 60 preterm neonates, 15 of them during their hospital study developed NEC. Of these 15 NEC developed cases, two of them showed no decrease in blood monocyte counts. In rest of the thirteen cases a drop in blood monocyte concentration of -2.94/4 was seen in NEC ones and -330/4 in advanced NEC cases. During the course of the study 6 of the NEC developed patients expired accounting to 40% to the total number of participants.

Conclusion: An acute drop in blood monocyte concentration identified NEC in 13 of 15 neonates. In an infant with signs of NEC, a percentage wise fall in AMC by -2.94/4 indicated NEC with increased drop in advanced cases by -3.30/4.

Implications: Acute drop in AMC will help diagnose NEC in its early stages to provide timely management and avoid any aggravation.