WOFAPS 2025 8th World Congress of Pediatric Surgery

Keisuke Yano ¹, Koshiro Sugita ¹, Toshio Harumatsu ¹, Makoto Matsukubo ², Takafumi Kawano ¹, Mitsuru Muto ¹, Motofumi Torikai ², Satoshi Ibara ³, Takuya Tokuhisa ³, Satoshi Ieiri ¹

¹ Department of Pediatric Surgery, Kagoshima University
² Department of Pediatric Surgery, Kagoshima City Hospital
³ Department of Neonatology, Kagoshima City Hospital

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 surgical NEC and control groups.

Results: Two hundred forty-six ELBWIs were enrolled in this study (control group, n=190; surgical NEC group, n=22). The body weight at birth of surgical NEC group was lower than the Control group. 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.