Predictive Value of Serum Total Calcium for Surgical Intervention in Neonatal Necrotizing Enterocolitis: A Single-Center Retrospective Case-Control Study

Abstract Background Serum calcium is a prognostic marker in severe infections, yet its association with surgical intervention in neonatal necrotizing enterocolitis (NEC) remains unclear. This study evaluated the independent predictive value of serum total calcium (TCa) measured within 24 h of disease onset for surgical treatment in NEC. Methods This single-center retrospective case-control study enrolled 181 neonates with Bell's stage ≥ II NEC at the First Affiliated Hospital of Anhui Medical University (January 2016–June 2025), divided into conservative (n = 126) and surgical (n = 55) groups. Maternal, neonatal, and laboratory data collected within 24 h of NEC onset were retrieved. After univariate screening, variables were reduced by least absolute shrinkage and selection operator (LASSO) regression and entered into multivariate logistic regression to identify independent risk factors. Predictive efficacy was assessed by receiver operating characteristic (ROC) curve analysis, and correlations between TCa and inflammatory markers by Spearman rank analysis. Results Of the 181 neonates, 55 (30.4%) underwent surgical treatment. The surgical group had significantly lower gestational age, birth weight, and TCa, and higher C-reactive protein (CRP) and procalcitonin (PCT) levels. Multivariate logistic regression identified elevated CRP (OR = 1.018, 95% CI 1.007–1.030; P = 0.003), elevated PCT (OR = 1.014, 95% CI 1.002–1.027; P = 0.032), and decreased TCa (OR = 0.025, 95% CI 0.002–0.227; P = 0.002) as independent risk factors for surgical intervention. TCa showed higher predictive accuracy (Area under the Curve [AUC] = 0.733, 95% CI 0.653–0.813) than CRP (AUC = 0.665, 95% CI 0.574–0.756) and PCT (AUC = 0.718, 95% CI 0.636–0.801). TCa was weakly negatively correlated with CRP ( r s = − 0.198, P < 0.05) and PCT ( r s = − 0.294, P < 0.001). Conclusions Serum TCa measured within 24 h of disease onset is significantly associated with surgical treatment in NEC and may serve as a valuable adjunctive indicator for evaluating surgical indications.