The Role of Monocyte Count in Predicting the Severity of Necrotizing Enterocolitis in Egyptian Preterm Neonates: A Multicenter Study

Abstract Background: Necrotizing enterocolitis (NEC) is one of the most serious and common gastrointestinal medical/surgical emergencies in preterm neonates. Aim of Study: To determine the diagnostic accuracy of monocyte count in diagnosis of NEC and whether the degree of monocyte count drop at the onset of necrotizing enterocolitis correlates with severity of disease which in turns will help in early diagnosis and treatment of the disease. Patients and Methods: It was conducted on 150 preterm neonates in Neonatal Intensive Care Units of Abu El Reesh El Mounira Children Hospital, Cairo University Hospital and Misr University for Science and Technology Hospital. Results: The data first highlighted the presence of meta-bolic acidosis in both groups. Significantly more infants in the NEC group experienced metabolic acidosis (78.0%) compared to the control group (46.0%), with a highly significant p-val-ue of less than 0.001. This indicated a strong positive associa-tion between metabolic acidosis and the development of NEC. Metabolic acidosis, which reflected an imbalance between acid production and elimination in the body, might indicate com-promised perfusion and oxygenation of tissues, potentially con-tributing to the pathogenesis of NEC. The study revealed that monocyte values at the onset of NEC were lower in the NEC group compared to the control group. In this analysis, Stage I and Stage II NEC cases were compared in terms of their mono-cytes values. The mean monocyte count for Stage I NEC was 12.71, while for Stage II NEC, it was 10.83. The data indicated a statistically significant difference in monocyte count between these two stages (p-value = 0.010), with a mean difference of 1.881. The confidence interval of 95% ranged from 0.161 to 3.6, which suggested that the true difference in monocyte count between the two stages could lie within this interval with 95% confidence. This result implied that Stage II NEC cases had a lower mean monocyte count compared to Stage I NEC cases. Conclusion: The findings collectively suggest that in-terrupted feeding, formula feeding, sepsis, specific bacterial strains, and the use of inotropes and blood transfusions are strongly linked to the incidence of NEC in preterm neonates. On the other hand, certain factors such as gender, gestational age, and Apgar scores may not be significantly linked to NEC. Additionally, the analysis highlights the ROC of monocytes values with a diagnostic accuracy of 0.636 for NEC and 0.793 for stage II NEC which demonstrates excellent sensitivity and specificity. These insights contribute to a deeper understand-ing of the multifaceted nature of NEC development and high-light the importance of targeted interventions, infection control measures, and close monitoring to mitigate its risk in neonatal care settings.