Potential predictors of necrotizing enterocolitis in extremely low-birth-weight infants: Analyses of coagulation and fibrinolysis markers at birth at a single institution during the past decade

Abstract Purpose We analyzed coagulation and fibrinolysis markers at birth to identify predictors of the onset of necrotizing enterocolitis (NEC) in extremely low-birth-weight infants (ELBWIs). Methods We reviewed the medical records of ELBWIs born at our institution between 2013 and 2022. Patient background and blood test results at birth were compared between the NEC and control groups. Results Two hundred forty-six ELBWIs were enrolled in this study (control group, n = 226; NEC group, n = 20). The background characteristics were significantly difference between the two groups. The following coagulation and fibrinolysis markers at birth were compared between the control and NEC groups: prothrombin time (%), 62.2 ± 19.4 vs. 54.2 ± 24.4, p = 0.169; prothrombin ratio, 1.65 ± 0.55 vs. 1.39 ± 0.27, p = 0.052; activated partial thromboplastin time (min), 78.5 ± 31.1 vs. 95.6 ± 40.6, p = 0.083; fibrinogen (mg/dL), 160.7 ± 124.2 vs. 107.3 ± 67.1, p = 0.004; antithrombin III (%), 29.1 ± 7.8 vs. 28.4 ± 9.9, p = 0.083; D-dimer (µg/mL), 3.2 ± 2.5 vs. 11.7 ± 13.9, p = 0.013; soluble fibrin (µg/mL), 30.0 ± 26.9 vs. 35.7 ± 25.4, p = 0.372; thrombin antithrombin III complex (ng/mL), 9.0 ± 7.9 vs. 20.5 ± 28.1, p = 0.082; plasmin-α2 plasmin inhibitor complex (µg/mL), 1.04 ± 0.67 vs. 1.88 ± 3.0, p = 0.254; plasminogen activator inhibitor-1 (ng/mL), 23.0 ± 14.3 vs. 42.5 ± 59.5, p = 0.160; and factor XIII (%), 25.7 ± 8.2 vs. 24.7 ± 9.7; p = 0.667. Conclusions Low fibrinogen and high D-dimer levels at birth are potential predictors of the onset of NEC in ELBWIs.