J Pediatr Infect Dis
DOI: 10.1055/s-0044-1781428
Original Article

Comparison of Preoperative and Postoperative Neutrophil/Lymphocyte Ratio in Predicting Mortality in Neonates with Intestinal Atresia

1   Department of Pediatric Surgery, University of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
,
1   Department of Pediatric Surgery, University of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
› Author Affiliations

Abstract

Objective Congenital intestinal atresia is one of the most common surgical pathologies in the neonatal period. This study aimed to compare the efficacy of preoperative neutrophil/lymphocyte ratio (NLR) and postoperative NLR in predicting early mortality in neonates with intestinal atresia.

Methods The data of 38 newborns with intestinal atresia operated on in our hospital between January 2016 and March 2023 were retrospectively analyzed. Patients' gestational age, gender, birth weight, other congenital anomalies, operative findings, length of hospital stay, sepsis, and mortality rates were recorded. NLR was calculated by analyzing preoperative and postoperative day 1 complete blood tests.

Results Of the patients included in the study, 60.5% were male and 39.5% were female. The median birth weight was 2,468 g (600–3,800 g), and the median gestational age was 36 weeks (28–40 weeks). Gender, number of areas of atresia in the gut, and development of sepsis were not associated with mortality. Mortality was observed at a lower rate in duodenal atresia when compared with the other types of atresia (p < 0.05). The mortality was higher in patients with prematurity, low birth weight, long duration of mechanical ventilation, and severe congenital anomalies (p < 0.05). Preoperative lymphocyte and neutrophil counts were not found to be predictive of mortality. The mortality rate increased as the postoperative lymphocyte count decreased and as the neutrophil count increased (p < 0.05). The preoperative and postoperative NLR was not useful in predicting mortality, the development of sepsis, or the need for reoperation.

Conclusion It is possible to predict early mortality in newborns with intestinal atresia who underwent surgery with neutrophil and lymphocyte counts on the first day after surgery. However, early NLR is not useful in predicting prognosis after surgery in newborns.

Ethical Approval Statement

This study was approved by the Clinical Research Ethics Committee of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital University (23.06.2023/Number: 435).




Publication History

Received: 04 October 2023

Accepted: 28 December 2023

Article published online:
28 March 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Silahli M, Tekin M. Albumin haemoglobin index: a novel pre-operative marker for predicting mortality and hospital stay in patients under one-year undergoing gastrointestinal surgeries. Afr J Paediatr Surg 2022; 19 (02) 89-96
  • 2 Hao J, Zhang Y, Tianyu L. et al. Preliminary investigation of the diagnosis of neonatal congenital small bowel atresia by ultrasound. BioMed Res Int 2019; 2019: 7097159
  • 3 Al-Jahdali F, Alsania MA, Almagushi AA, Alsaqqat MT, Alnamshan MK. Risk factors and short outcome of bowel atresia in neonates at tertiary hospital. Afr J Paediatr Surg 2018; 15 (02) 108-110
  • 4 Sirelkhatim EE, Mohamadain AA, Hamza AA. Small bowel atresia in Khartoum Teaching Hospital. Global J Med Res Interdiscipl 2013; 13: 6
  • 5 Sharma P, Pawar N, Gupta AK. Congenital intrinsic duodenal obstruction: clinical study and predictors of neonatal surgical mortality. J Neonatal Surg 2022; 11: 9
  • 6 Hassan HN. Factors associated with intestinal atresia and its complications. Adv Health Sci Res 2021; 37: 99-102
  • 7 Goodluck G, Gnanamuttupulle M, Sadiq A, Msuya D, Chugulu S, Lodhia J. Jejunoileal atresia in a newborn: our experience from Northern Tanzania and literature review. Clin Med Insights Pediatr 2022; 16: 11 795565221075313
  • 8 Sholadoye TT, Mshelbwala PM, Ameh EA. Presentation and outcome of treatment of jejunoileal atresia in Nigeria. Afr J Paediatr Surg 2018; 15 (02) 84-87
  • 9 Çolakoğlu ŞM, Genç Moralar D, Çekmecelioğlu BT, Hergünsel GO. Relationship of mortality with neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume in patients undergoing acute abdominal surgery. Ulus Travma Acil Cerrahi Derg 2020; 26 (05) 735-741
  • 10 Ortiz-López D, Acosta-Mérida MA, Casimiro-Pérez JA, Silvestre-Rodríguez J, Marchena-Gómez J. First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. Rev Gastroenterol Mex (Engl Ed) 2022; (02) 142-148
  • 11 Savluk OF, Guzelmeric F, Yavuz Y. et al. Neutrophil-lymphocyte ratio as a mortality predictor for Norwood stage I operations. Gen Thorac Cardiovasc Surg 2019; 67 (08) 669-676
  • 12 Celik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 2019; 25 (03) 222-228
  • 13 Gao P, Liu J, Wang X. et al. The association between neutrophil-lymphocyte ratio and poor outcomes following infant cardiac surgery. BMC Cardiovasc Disord 2021; 21 (01) 529
  • 14 Hosseini SV, Maleknejad A, Salem SA, Pourahmad S, Zabangirfard Z, Zamani M. The pre- and postoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: the comparison of laparoscopy and laparotomy in colorectal cancer patients. Asian J Endosc Surg 2022; 15 (01) 44-50
  • 15 Faraoni D, Zurakowski D, Vo D. et al. Post-operative outcomes in children with and without congenital heart disease undergoing noncardiac surgery. J Am Coll Cardiol 2016; 67 (07) 793-801
  • 16 Lian C, Xie Z, Wang Z. et al. Pediatric preoperative risk factors to predict postoperative ICU admission and death from a multicenter retrospective study. Paediatr Anaesth 2016; 26 (06) 637-643
  • 17 Li K, Peng YG, Yan RH, Song WQ, Peng XX, Ni X. Age-dependent changes of total and differential white blood cell counts in children. Chin Med J (Engl) 2020; 133 (16) 1900-1907
  • 18 Moosmann J, Krusemark A, Dittrich S. et al. Age- and sex-specific pediatric reference intervals for neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio. Int J Lab Hematol 2022; 44 (02) 296-301
  • 19 Jones SM, McCracken C, Alsoufi B, Mahle WT, Oster ME. Association of preoperative cell counts with outcomes after operation for congenital heart disease. Ann Thorac Surg 2018; 106 (04) 1234-1240
  • 20 Chiarelli M, Achilli P, Tagliabue F. et al. Perioperative lymphocytopenia predicts mortality and severe complications after intestinal surgery. Ann Transl Med 2019; 7 (14) 311
  • 21 Benlice C, Onder A, Babazade R. et al. Is the neutrophil-to-lymphocyte ratio associated with increased morbidity after colorectal surgery?. Surg Laparosc Endosc Percutan Tech 2019; 29 (01) 36-39
  • 22 Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L. Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. ANZ J Surg 2015; 85 (06) 414-419
  • 23 Da Silva M, Cleghorn MC, Elnahas A, Jackson TD, Okrainec A, Quereshy FA. Postoperative day one neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes in bariatric surgery patients. Surg Endosc 2017; 31 (06) 2645-2650
  • 24 Palomero-Rodrı'guez MA, Chozas de Arteaga H, Laporta-Ba'ez Y. de Vicente-Sa'nchez J, Pe' rez-Ferrer A. Neutrophil to lymphocyte ratio compared with C reactive protein to predict infection after major surgery in pediatric patients. Pediatr Infect Dis 2016; 8: 124-127
  • 25 Dursun A, Ozsoylu S, Akyildiz BN. Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children. Pak J Med Sci 2018; 34 (04) 918-922
  • 26 Xin Y, Shao Y, Mu W, Li H, Zhou Y, Wang C. Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMJ Open 2022; 12 (12) e060391
  • 27 Bai L, Gong P, Jia X. et al. Comparison of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMC Pediatr 2023; 23 (01) 334
  • 28 Zhang J, Zeng J, Zhang L, Yu X, Guo J, Li Z. The utility of peripheral blood leucocyte ratios as biomarkers in neonatal sepsis: a systematic review and meta-analysis. Front Pediatr 2022; 10: 908362
  • 29 Nayak A, McDowell DT, Kellie SJ, Karpelowsky J. Elevated preoperative neutrophil-lymphocyte ratio is predictive of a poorer prognosis for pediatric patients with solid tumors. Ann Surg Oncol 2017; 24 (11) 3456-3462
  • 30 Forget P, Dinant V, De Kock M. Is the neutrophil-to-lymphocyte ratio more correlated than C-reactive protein with postoperative complications after major abdominal surgery?. PeerJ 2015; 3: e713
  • 31 Min KW, Kwon MJ, Kim DH. et al. Persistent elevation of postoperative neutrophil-to-lymphocyte ratio: a better predictor of survival in gastric cancer than elevated preoperative neutrophil-to-lymphocyte ratio. Sci Rep 2017; 7 (01) 13967