Lactate trajectory patterns in neonatal necrotizing enterocolitis: an exploratory retrospective cohort study using group-based trajectory modeling

Abstract

Abstract Background Necrotizing enterocolitis (NEC) is a devastating neonatal condition with high mortality, yet early identification of infants at highest risk remains challenging. Lactate dynamics may offer prognostic value beyond single measurements, yet statistical trajectory patterns in NEC remain unexplored, particularly in real-world settings with substantial data missingness. Methods This retrospective cohort study included 106 neonates with NEC from the Pediatric Intensive Care Database, grouped into three categories: non-surgical ( n = 63), early surgery (≤ 3 days, n = 18), and late surgery (> 3 days, n = 25). Group-based trajectory modeling (GBTM) was applied within each stratum to identify lactate trajectory patterns (posterior probability > 0.7). Postoperative lactate measurements within 24 h were excluded. Bootstrap resampling (300 replicates) assessed parameter stability in the non-surgical group. Results GBTM identified trajectory patterns linked to management decisions. A high-and-rising trajectory pattern (initial lactate 11.39 mmol/L, increase 4.93 mmol/L/day) occurred in 2 non-surgical neonates (3.2%) and was associated with 100% mortality within 48 h. All 43 surgical patients survived, exhibiting stable or clearing trajectories. Bootstrap analysis confirmed model stability in the non-surgical group, with a coefficient of variation < 30% for all. Conclusion This exploratory study identified a steeply rising lactate trajectory associated with early mortality in NEC, suggesting that dynamic lactate trends may complement static markers for risk assessment, pending prospective validation. Trial registration Clinical trial number: not applicable.