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Objective: To investigate the predictive value of serum amyloid A (SAA), C-reactive protein (CRP), platelet distribution width (PDW) and neutrophil/lymphocyte ratio (NLR) for the timing of neonatal necrotizing enterocolitis (NEC) surgery.Methods: 70 children with NEC who were admitted to Foshan Maternal and Child Health Hospital from January 2019 to January 2022were selected, and they were divided into surgery group with 35 cases and non-surgery group with 35 cases according to treatment methods. Clinical data of children with NEC were collected, and the levels of serum SAA, CRP, peripheral blood PDW and NLR in the two groups were detected. Univariate and multivariate Logistic regression were used to analyze the influencing factors of neonatal NEC surgery. The predictive value of serum SAA, CRP, peripheral blood PDW and NLR on the timing of neonatal NEC surgery was analyzed by receiver operating characteristic (ROC) curve. Results: The gestational age ≥37 weeks and the proportion of weight ＞2500 g at diagnosis in the surgery group were lower than those in the non-surgery group, the proportion of weight 1500～2500 g at diagnosis, poor mental response, abdominal distension, weak bowel sound and the levels of serum SAA, CRP, peripheral blood PDW and NLR were higher than those in the non-surgery group (all P＜0.05). Multivariate Logistic regression analysis showed that weight＞2500 g at diagnosis was an independent protective factor for neonatal NEC surgery, poor mental response, abdominal distension, weak bowel sound and increased levels of serum SAA, CRP, PDW and NLR were independent risk factors for neonatal NEC surgery (all P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of the combination of serum SAA, CRP, peripheral blood PDW and NLR in predicting the timing of neonatal NEC surgery was greater than that of each indicator alone. Conclusion: The increase levels of serum SAA, CRP, peripheral blood PDW and NLR are closely related to neonatal NEC surgery, and the combined value of these four indicators in predicting the timing of neonatal NEC surgery is higher [ABSTRACT FROM AUTHOR]