Su Pengjun,Zhang Zhibo.Clinical characteristics and risk factors of extensive necrotizing enterocolitis in preterm infants[J].Journal of Clinical Pediatric Surgery,,21():315-319.[doi:10.3760/cma.j.cn101785-202201059-004]
Clinical characteristics and risk factors of extensive necrotizing enterocolitis in preterm infants
- Keywords:
- Enterocolitis; Necrotizing/DI; Enterocolitis; Necrotizing/SU; Necrotizing enterocolitis totalis; Treatment outcome; Infant; Premature; Case-Control Studies
- Abstract:
- ObjectiveTo explore the clinical characteristics of extensive necrotizing enterocolitis (NEC-T) in preterm infants and the related factors of total intestinal necrosis.MethodsFrom January 2011 to December 2020,clinical data were reviewed retrospectively for 42 NEC-T preterm infants (NEC-T group).And,during the same period,no necrotizing enterocolitis totalis (NEC-nonT) preterm infants (NEC-nonT group,including operation and non-operation sub-groups) were compared.The related factors of total intestinal necrosis were analyzed compared with NEC-nonT.ResultsForty-two NEC-T children accounted for 6.1%(42/686) of the total number of NEC during the same period.Compared with NEC-nonT counterparts,NEC-T preterm infants had a lower birth weight [(1501±740) vs.(1709±1102) grams] and a higher asphyxia rate[76.2%(32/42) vs.25%(161/644)].The differences were statistically significant.Compared with NEC-nonT group,age of onset was younger [(7.8±7.6) vs.(14.6±13.4) days],time interval between onset and operation was shorter [(6.6±6.5) vs. (30.4±24.4) days],higher ratio of Bell phase Ⅲ[85.7%(36/42) vs.62.7%(404/644)],greater rate of post-onset shock [76.2%(32/42) vs.36.6%(236/644)] and higher mortality rate[100%(42/42) vs.5.0%(32/644)].The differences were statistically significant.Analysis of related factors of intestinal necrosis: severe subwall pneumatosis in two groups in acute stage [52.4%(22/42) vs.21.0%(76/362)],hypotension [69.0%(29/42) vs.40.3%(146/362)],pneumoperitoneum[66.7%(28/42) vs.40.3%(176/362)],hyponatremia [85.7%(36/42) vs.51.4%(186/362)],abdominal erythema [88.1%(37/42) vs.18.2%(66/362)] and thrombocytopenia[85.7%(36/42) vs.15.5%(56/362)].NEC-T group was significantly higher than NEC-nonT group and the difference was statistically significant; Logistic multiple stepwise regression analysis indicated that abdominal erythema,severe subwall pneumatosis,hyponatremia and thrombocytopenia were independent risk factors for NEC-T (P<0.05).NEC-T score: 3 had 92% sensitivity and 68% specificity to NEC-T while the sensitivity of 5 decreased by 54% and the specificity was significantly higher than 98%.ConclusionNEC-T premature infants have severe clinical symptoms,rapid disease progression and a high mortality.Newnates with NEC-T risk factors require close observations,reasonable analysis,early prevention and intervention to reduce the incidence and mortality of NEC.
References:
[1] Eaton S,Rees CM,Hall NJ.Current research on the epidemiology,pathogenesis,and management of necrotizing enterocolitis[J].Neonatology,2017,111(4):423-430.DOI:10.1159/000458462.
[2] Rich BS,Dolgin SE.Necrotizing enterocolitis[J].Pediatr Rev,2017,38(12):552-559.DOI:10.1542/pir.2017-0002.
[3] Santana DS,Surita FG,Cecatti JG.Multiple pregnancy:epidemiology and association with maternal and perinatal morbidity[J].Rev Bras Ginecol Obstet,2018,40(9):554-562.DOI:10.1055/s-0038-1668117.
[4] Lambert DK,Christensen RD,Baer VL,et al.Fulminant necrotizing enterocolitis in a multihospital healthcare system[J].J Perinatol,2012,32(3):194-198.DOI:10.1038/jp.2011.61.
[5] Hammond PJ,Flett ME,De La Hunt M.Fulminant necrotising enterocolitis immediately following change to low birth weight formula feeds[J].Eur J Pediatr Surg,2008,18(3):185-187.DOI:10.1055/s-2008-1038440.
[6] Hackam DJ.Letter to the editor:Rebuttal[J].J Pediatr Surg,2014,49(12):1872.DOI:10.1016/j.jpedsurg.2014.09.057.
[7] Kosloske AM.Indications for operation in necrotizing enterocolitis revisited[J].J Pediatr Surg,1994,29(5):663-666.DOI:10.1016/0022-3468(94)90736-6.
[8] Thompson A,Bizzarro M,Yu S,et al.Risk factors for necrotizing enterocolitis totalis:a case-control study[J].J Perinatol,2011,31(11):730-738.DOI:10.1038/jp.2011.18.
[9] Hsueh W,Caplan MS,Qu XW,et al.Neonatal necrotizing enterocolitis:clinical considerations and pathogenetic concepts[J].Pediatr Dev Pathol,2003,6(1):6-23.DOI:10.1007/s10024-002-0602-z.
[10] Munaco AJ,Veenstra MA,Brownie E,et al.Timing of optimal surgical intervention for neonates with necrotizing enterocolitis[J].Am Surg,2015,81(5):438-443.
[11] Raval MV,Hall NJ,Pierro A,et al.Evidence-based prevention and surgical treatment of necrotizing enterocolitis-a review of randomized controlled trials[J].Semin Pediatr Surg,2013,22(2):117-121.DOI:10.1053/j.sempedsurg.2013.01.009.
[12] Tepas JJ 3rd,Sharma R,Leaphart CL,et al.Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement[J].J Pediatr Surg,2010,45(2):310-314.DOI:10.1016/j.jpedsurg.2009.10.069.
[13] Kosloske AM.Indications for operation in necrotizing enterocolitis revisited[J].J Pediatr Surg,1994,29(5):663-666.DOI:10.1016/0022-3468(94)90736-6.
[14] Khalak R,D’Angio C,Mathew B,et al.Physical examination score predicts need for surgery in neonates with necrotizing enterocolitis[J].J Perinatol,2018,38(12):1644-1650..DOI:10.1038/s41372-018-0245-1.
Memo
收稿日期:2022-01-30;改回日期:。
通讯作者:张志波,Email:zhangzb@sj-hospital.org