Coagulation and fibrinolysis markers at birth as early predictors of surgical necrotizing enterocolitis in extremely low-birth-weight infants.

PURPOSE: Early identification of surgical necrotizing enterocolitis (S-NEC) before clinical deterioration remains challenging in extremely low-birth-weight infants (ELBWIs). We evaluated whether coagulation and fibrinolysis markers at birth could predict subsequent S-NEC.

METHODS

We retrospectively analyzed 250 ELBWIs (< 1000 g) treated from 2013 to 2022; 22 developed S-NEC. Eleven coagulation and fibrinolysis markers were measured within 24 h of birth. Multivariable logistic regression models and a simple birth-time risk score were developed.

RESULTS

Relative to controls, S-NEC infants had higher D-dimer (11.7 vs. 5.5 µg/mL, p = 0.003) and PT-INR (1.71 vs. 1.42, p = 0.023), prolonged PT (62.2 vs. 52.7 s, p = 0.022), and lower fibrinogen (107.3 vs. 160.7 mg/dL, p = 0.037). Multivariable models showed stepwise improvement in discrimination (AUC 0.668, 0.710, 0.763). A four-item risk score (D-dimer > 5 µg/mL, PT-INR > 1.5, fibrinogen < 100 mg/dL, and birth weight < 700 g) achieved an AUC of 0.702, with 85.0% sensitivity and 96.3% negative predictive value (NPV). S-NEC incidence increased across risk categories (3.7%, 14.5%, and 19.6%; p for trend = 0.013).

CONCLUSIONS

Hemostatic abnormalities at birth were associated with subsequent S-NEC in ELBWIs, suggesting perinatal or intrauterine origins. The risk score showed a high NPV and may serve as a practical rule-out tool for early neonatal intensive care unit stratification.