Exploring the predictive value of pH in stratified mortality risk of NEC patients undergoing surgery: a retrospective study based on the PIC database.

Background: Neonatal necrotizing enterocolitis (NEC) represents a severe gastrointestinal condition characterized by a high mortality rate, with a paucity of reliable prognostic biomarkers. The presence of an acidic pH, indicative of systemic acidosis and intestinal ischemia, has potential as a predictor of adverse outcomes. However, the relationship between pH levels and inflammatory markers, as well as its applicability across surgical and non-surgical patient subgroups, remains inadequately understood. Utilizing data from pediatric intensive care units, this study investigates the prognostic significance of pH in stratifying mortality risk in NEC and examines its association with variations in neutrophil and leukocyte counts.

Methods: Clinical and laboratory data of NEC patients were collected from pediatric critical care datasets. The population was stratified based on whether surgical treatment was performed. Each stratum was further divided into two groups: the mortality group and the discharge group. Intergroup comparisons and multivariate analyses were conducted to evaluate the predictive value of acidic pH levels for outcomes in NEC patients.

Results: A total of 124 NEC neonates were included, with a median age at admission of 9 days and a median weight of 2.34 kg. In both the non-surgical and surgical subgroups, neonates in the mortality group exhibited acidic pH levels. Multivariate regression analysis in the surgical group identified acidic pH as a risk factor for adverse outcomes. Among all NEC neonates, stratification based on pH levels revealed the highest mortality rate in the acidic pH group. A generalized linear regression model using pH as the dependent variable demonstrated that, in addition to conventional factors such as lactate and potassium (K+), increases in neutrophils and white blood cells (WBCs) also contributed to pH variations.

Conclusions: Acidic pH is closely associated with adverse outcomes in NEC neonates. Inflammation-related increases in WBC and neutrophils may reflect changes in pH levels in these patients.