{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:47:28Z","timestamp":1767340048807,"version":"3.41.2"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore early surgical indications and clinical predictive factors for neonatal necrotizing enterocolitis (NEC) to improve the prognosis of affected infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on the clinical data of 146 infants diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2015 to December 2020. The infants were divided into two groups: the surgical treatment group (56 cases) and the non-surgical treatment group (90 cases). Maternal perinatal conditions, general infant characteristics, clinical manifestations, comorbidities, laboratory tests, and imaging findings were statistically analyzed. Significant factors were further analyzed using multivariate logistic regression, and predictive indicators were assessed by the receiver operating characteristic (ROC) curve and Youden's index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Statistically significant differences were observed between the two groups in birth weight, gestational age, abdominal wall erythema, absent bowel sounds, lethargy, fever, peritonitis, septic shock, metabolic acidosis, neonatal acute respiratory distress syndrome, and asphyxia (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). No significant differences were found in maternal perinatal conditions, sex, feeding method, age at onset, abdominal distention, bloody stool, vomiting, gastric retention, apnea, neonatal pneumonia, neonatal hyperbilirubinemia, sepsis, electrolyte disturbances, or respiratory failure (<jats:italic>P<\/jats:italic>\u2009&amp;gt;\u20090.05). Laboratory and imaging markers such as prealbumin, IL-6, PCT, CRP, WBC, pneumoperitoneum, bowel wall gas, and portal venous gas showed statistically significant differences (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). Multivariate logistic regression identified peritonitis (OR\u2009=\u200995.635), IL-6 (OR\u2009=\u20091.001), and portal venous gas (OR\u2009=\u200922.551) as independent risk factors for early surgery in NEC (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). ROC curve analysis revealed that IL-6 (AUC\u2009=\u20090.875) and PCT (AUC\u2009=\u20090.798) demonstrated good predictive performance for early surgical intervention. The optimal cutoff values were 476\u2005pg\/ml for IL-6 (sensitivity 80.4%, specificity 85.6%) and 1.53\u2005ng\/ml for PCT (sensitivity 83.9%, specificity 70%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Peritonitis and portal venous gas are independent risk factors for early surgery in NEC. IL-6 and PCT are reliable predictive markers for determining the need for early surgical intervention in NEC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1571921","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T09:59:03Z","timestamp":1747735143000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of early surgical indications and related factors in neonatal necrotizing enterocolitis"],"prefix":"10.3389","volume":"13","author":[{"given":"Xianhui","family":"Shang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huinan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanmei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuefeng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luping","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiyu","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"F265","DOI":"10.1136\/archdischild-2017-314435","article-title":"Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis","volume":"104","author":"Hau","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B2","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s12887-020-02231-5","article-title":"Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis","volume":"20","author":"Alsaied","year":"2020","journal-title":"BMC Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.clp.2018.09.008","article-title":"Does surgical management alter outcome in necrotizing enterocolitis?","volume":"46","author":"Carr","year":"2019","journal-title":"Clin Perinatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7499\/j.issn.1008-8830.2011145","article-title":"Clinical guidelines for the diagnosis and treatment of neonatal necrotizing enterocolitis (2020)","volume":"23","year":"2021","journal-title":"Chin J Contemp Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"530","DOI":"10.3760\/cma.j.cn101785-202007046-006","article-title":"Comparative study of postoperative outcomes in neonates with necrotizing enterocolitis with and without intestinal perforation","volume":"21","author":"Han","year":"2022","journal-title":"J Clin Pediatr Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"361","DOI":"10.3969\/j.issn.1671-6353.2019.05.005","article-title":"Application of procalcitonin, interleukin-6, and C-reactive protein in determining surgical timing for neonatal necrotizing enterocolitis","volume":"18","author":"Zheng","year":"2019","journal-title":"J Clin Pediatr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1097\/JPN.0000000000000088","article-title":"Disease prediction strategies for necrotizing enterocolitis","volume":"29","author":"Gregory","year":"2015","journal-title":"J Perinat Neonatal Nurs"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1038\/s41372-020-0722-1","article-title":"Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis","volume":"40","author":"Patel","year":"2020","journal-title":"J Perinatol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e7400","DOI":"10.1097\/MD.0000000000007400","article-title":"Circulating fibrocytes are involved in inflammation and leukocyte trafficking in neonates with necrotizing enterocolitis","volume":"96","author":"Liu","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1056\/NEJMoa1403489","article-title":"Causes and timing of death in extremely premature infants from 2000 through 2011","volume":"372","author":"Patel","year":"2015","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3760\/cma.j.issn.2096-2932.2023.01.007","article-title":"Risk factor analysis for surgical treatment in neonates with necrotizing enterocolitis","volume":"38","author":"Zhong","year":"2023","journal-title":"Chin J Neonatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"352","DOI":"10.3969\/j.issn.1671-6353.2019.05.003","article-title":"Advances in the etiology and diagnosis of neonatal necrotizing enterocolitis","volume":"18","author":"L\u00fc","year":"2019","journal-title":"J Clin Pediatr Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"306","DOI":"10.3760\/cma.j.cn101785-202201045-002","article-title":"Neonatal necrotizing enterocolitis: interpretation of bell staging and determination of surgical indications","volume":"21","author":"Zhang","year":"2022","journal-title":"J Clin Pediatr Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.pedneo.2016.10.004","article-title":"Necrotizing enterocolitis in low birth weight infants in China: mortality risk factors expressed by birth weight categories","volume":"58","author":"Qian","year":"2017","journal-title":"Pediatr Neonatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"dmm040998","DOI":"10.1242\/dmm.040998","article-title":"Formula feeding and immature gut microcirculation promote intestinal hypoxia, leading to necrotizing enterocolitis","volume":"12","author":"Chen","year":"2019","journal-title":"Dis Model Mech"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1107404","DOI":"10.3389\/fped.2022.1107404","article-title":"Necrotizing enterocolitis:bench to bedside approaches and d advancing our understanding of disease pathogenesis","volume":"10","author":"Singh","year":"2023","journal-title":"Front Pediatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"724","DOI":"10.3760\/cma.j.issn.0253-3006.2016.10.002","article-title":"Expert consensus on surgical treatment of neonatal necrotizing enterocolitis","volume":"37","year":"2016","journal-title":"Chin J Pediatr Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1571921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T09:59:08Z","timestamp":1747735148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1571921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":17,"alternative-id":["10.3389\/fped.2025.1571921"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1571921","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2025,5,20]]},"article-number":"1571921"}}