Can the systemic immune-inflammation index and the systemic inflammatory response score along with clinical findings predict the need for surgical intervention in necrotizing enterocolitis?
Asya Eylem Boztaş1
, Ayşe Demet Payza1, Suedagül Yıldırım Erkan1, Arzu Şencan2
1Department of Pediatric Surgery, Health Sciences University, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Türkiye
2Department of Pediatric Surgery, Health Sciences University, İzmir Faculty of Medicine, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Türkiye
Keywords: Inflammation marker, necrotizing enterocolitis, newborn.
Abstract
Objectives: The aim of this study was to assess the predictiveness of current biomarkers and identify parameters that could aid in decision-making regarding surgical intervention in necrotizing enterocolitis (NEC).
Patients and methods: Eighty-one neonates (44 females, 37 males; mean age at NEC diagnosis: 19.37 ± 13.54 days; range, 5 to 90 days) diagnosed with NEC in a tertiary-level pediatric referral hospital between January 2014 and December 2024 were retrospectively examined. Patients’ demographic data, laboratory tests, including inflammation scores [SII and SIRI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)], ultrasonography findings, abdominal radiograph findings, and physical examination findings, were compared between medical and surgical NEC groups. The data were analyzed to assess the predictive importance of inflammation markers for the identification of patients needing surgical intervention.
Results: Overall, 47 (58%) patients required surgical intervention, and the mortality rate was 12.3%. There was no significant difference between groups in terms of gestational age, sex, age at diagnosis. The SII, NLR, C-reactive protein, and absolute neutrophil count were significantly higher in the surgical intervention group than in the medical treatment group (p < 0.05). However, the absolute lymphocyte count was lower in the surgical NEC group (p = 0.034). The SIRI score, white blood cell count, PLR, and MLR were not statistically significant predictive factors (p > 0.05). Length of hospital stay was longer in the medical NEC group (p < 0.05).
Conclusion: High values of SII, NLR, ANC, and low lymphocyte count can be considered adjunctive criteria alongside Bell’s staging system to facilitate the triage of premature neonates with NEC, thereby optimizing surgical decision-making and improving clinical outcomes. Prospective studies are needed to confirm their predictive value and refine surgical decision-making.
Citation:
Eylem Boztaş A, Payza AD, Yıldırım Erkan S, Şencan A. Can the systemic immune-inflammation index and the systemic inflammatory response score along with clinical findings predict the need for surgical intervention in necrotizing enterocolitis? Turkish J Ped Surg 2026;40(1):23-31. https://doi. org/10.62114/JTAPS.2026.201.