Chong Qingqi,Wang Zhiru,Lyu Zhibao,et al.Effects of multiple births upon the severity and outcomes of preterm infants with necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,,():405-412.[doi:10.3760/cma.j.cn101785-202204050-002]
Effects of multiple births upon the severity and outcomes of preterm infants with necrotizing enterocolitis
- Keywords:
- Necrotizing Enterocolitis; Multiple Birth; Twin; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the clinical characteristics of multiple-birth preterm infants with necrotizing enterocolitis (NEC) and examine the effects of multiple births on clinical manifestations and outcomes of NEC infants.Methods In this retrospective study, 234 premature infants with NEC admitted to Shanghai Children’s Hospital from July 2014 to June 2021 were included as research objects, among which 79 were multiple premature infants with NEC and 155 were single premature infants with NEC.According to the presence of single/multiple birth,they were divided into two groups of singleton (group A,n=155) and multiple-birth (group B,n=79).Twin group of vaginal delivery was divided into primary birth (group C,n=9) and secondary birth (group D,n=4) based upon birth order.Twin group was also assigned into two groups of higher birth weight (group E,n=20) and lower birth weight (group F,n=45).And twin group was divided into two groups of concordant twins (CT,group G,n=42) and discordant twins (DT,group H,n=26).The latter group was further divided into DT with higher birth weight (group I,n=5) and DT with lower birth weight (group J,n=21).Demographic profiles (birth weight,gestational age & birth mode),clinical data (time of NEC onset,laboratory results & Bell stage),treatment (medical or surgical,intestinal perforation & extent of disease) and outcomes (postoperative complications & in-hospital mortality) were recorded.Results Seventy-nine cases of multiple preterm NEC infants were recruited,including 75 twins and 4 triplets.Seventy-five preterm NEC twins had a mean gestational age of 31.60 weeks and a mean birth weight of 1 476.51 gram.Bell stage was Ⅰ (n=35),Ⅱ (n=21) and Ⅲ (n=19).Eighteen cases (24%) underwent operation.As compared with group A,NEC infants in group B had a lower birth weight [1 618.77±481.30) g,(1 479.34±376.88) g,P=0.016],higher rates of cesarean delivery [84(54.2%)vs.65(82.3%),P<0.001] and assisted reproductive technology [11(7.1%)vs.21(26.6%),P<0.001].However,no differences existed in demographic profiles,clinical manifestations,laboratory results,Bell stage,surgery or outcomes (P>0.05).There was no significant effect of birth order on demographic profiles,clinical manifestations,laboratory results,Bell stage,surgery or outcomes (P>0.05).As compared with group E,group F had a lower birth weight [(1 677.65±458.23) g vs.(1 382.89±300.81) g,P=0.019],lower WBC count [(12.31±4.22) vs.(9.13±4.01)×109/L,P=0.023],greater intestinal lesion [5(45.4%) vs.0(0.0%),P=0.002] and more postoperative complications [11(100%) vs.3(42.9%),P=0.011].No difference existed in demographic profiles,clinical manifestations,other laboratory results,Bell stage,surgery or in-hospital mortality (P>0.05).As compared with group G,group J had a greater gestational age [(30.95±2.44) vs.(32.71±2.30) week,P=0.027] and a higher rate of cesarean delivery [30 (71.4%) vs.20 (95.2%),P=0.045)].However,no differences existed in demographic profiles,clinical manifestations,laboratory results,Bell stage,surgery or outcomes (P>0.05).Conclusions Multiple-birth NEC infants have no greater severity of Bell stage,more surgery,greater extent of intestinal lesion,more postoperative complications or higher in-hospital mortality.Twins with lower birth weight are prone to greater extent of intestinal lesion and more postoperative complications.However,birth order and discordance of twins have no significant effect on disease severity,surgery or in-hospital mortality.
References:
[1] Neu J,Walker WA.Necrotizing enterocolitis[J].N Engl J Med,2011,364(3):255-264.DOI:10.1056/NEJMra1005408.
[2] Neu J.Necrotizing enterocolitis:the future[J].Neonatology,2020,117(2):240-244.DOI:10.1159/000506866.
[3] Alsaied A,Islam N,Thalib L.Global incidence of necrotizing enterocolitis:a systematic review and meta-analysis[J].BMC Pediatr,2020,20(1):344.DOI:10.1186/s12887-020-02231-5.
[4] Wennberg AL,Opdahl S,Bergh C,et al.Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology[J].Fertil Steril,2016,106(5):1142-1149.e14.DOI:10.1016/j.fertnstert.2016.06.021.
[5] Martin JA,Hamilton BE,Osterman MJK.Three decades of twin births in the United States,1980-2009[J].NCHS Data Brief,2012,80:1-8.
[6] Multifetal gestations:twin,triplet,and higher-order multifetal pre-gnancies:ACOG practice bulletin,number 231[J].Obstet Gynecol,2021,137(6):e145-e162.DOI:10.1097/AOG.0000000000004397.
[7] Walsh MC,Kliegman RM.Necrotizing enterocolitis:treatment ba-sed on staging criteria[J].Pediatr Clin North Am,1986,33(1):179-201.DOI:10.1016/s0031-3955(16)34975-6.
[8] Appleton C,Pinto L,Centeno M,et al.Near term twin pregnancy:clinical relevance of weight discordance at birth[J].J Perinat Med,2007,35(1):62-66.DOI:10.1515/JPM.2007.009.
[9] Berkhout DJC,Klaassen P,Niemarkt HJ,et al.Risk factors for necrotizing enterocolitis:a prospective multicenter case-control study[J].Neonatology,2018,114(3):277-284.DOI:10.1159/000489677.
[10] Chen LP,Lyu ZB,Gao ZM,et al.Human β-defensin-3 reduces excessive autophagy in intestinal epithelial cells and in experimental necrotizing enterocolitis[J].Sci Rep,2019,9(1):19890.DOI:10.1038/s41598-019-56535-3.
[11] 吕志宝,盛庆丰.新生儿坏死性小肠结肠炎的病因与诊治研究进展[J].临床小儿外科杂志,2019,18(5):352-355.DOI:10.3969/j.issn.1671-6353.2019.05.003. Lyu ZB,Sheng QF.Research advances in the etiologies,diagnoses and treatments of neonatal necrotizing enterocolitis[J].J Clin Ped Sur,2019,18(5):352-355.DOI:10.3969/j.issn.1671-6353.2019.05.003.
[12] Santana DS,Cecatti JG,Surita FG,et al.Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births:evidence from the Brazilian multicenter study on preterm birth(EMIP)[J].Int J Gynaecol Obstet,2020,149(2):184-191.DOI:10.1002/ijgo.13107.
[13] Cao XC,Zhang L,Jiang SY,et al.Epidemiology of necrotizing enterocolitis in preterm infants in China:a multicenter cohort study from 2015 to 2018[J].J Pediatr Surg,2022,57(3):382-386.DOI:10.1016/j.jpedsurg.2021.05.014.
[14] Burjonrappa SC,Shea B,Goorah D.NEC in twin pregnancies:incidence and outcomes[J].J Neonatal Surg,2014,3(4):45.
[15] 苏朋俊,吉耿锋,乔奇,等.双胞胎早产儿坏死性小肠结肠炎临床特点分析[J].中华实用儿科临床杂志,2021,36(19):1484-1487.DOI:10.3760/cma.j.cn101070-20200318-00447. Su PJ,Ji GF,Qiao Q,et al.Clinical characteristics of necrotizing enterocolitis in premature twins[J].Chin J Appl Clin Pediatr,2021,36(19):1484-1487.DOI:10.3760/cma.j.cn101070-20200318-00447.
[16] Sheng QF,Lyu ZB,Xu WJ,et al.Short-term surgical outcomes of preterm infants with necrotizing enterocolitis:a single-center experience[J].Medicine(Baltimore),2016,95(30):e4379.DOI:10.1097/MD.0000000000004379.
[17] Duchon J,Barbian ME,Denning PW.Necrotizing enterocolitis[J].Clin Perinatol,2021,48(2):229-250.DOI:10.1016/j.clp.2021.03.002.
[18] Gheorghe CP,Boring N,Mann L,et al.Neonatal outcomes and maternal characteristics in monochorionic diamniotic twin pregnancies:uncomplicated versus twin-to-twin transfusion syndrome survivors after fetoscopic laser surgery[J].Fetal Diagn Ther,2020,47(2):165-170.DOI:10.1159/000500858.
[19] Committee on Practice Bulletins-Obstetrics,Society for Maternal-Fetal Medicine.Practice bulletin No.169:multifetal gestations:twin,triplet,and higher-order multifetal pregnancies[J].Obstet Gynecol,2016,128(4):e131-e146.DOI:10.1097/AOG.0000000000001709.
[20] Heino A,Gissler M,Hindori-Mohangoo AD,et al.Variations in multiple birth rates and impact on perinatal outcomes in Europe[J].PLoS One,2016,11(3):e0149252.DOI:10.1371/journal.pone.0149252.
Memo
收稿日期:2022-04-14。
基金项目:上海市儿童医院临床研究专项(2023YLY07)
通讯作者:盛庆丰,Email:shengqingfeng@126.com