Kirsten G F, van Zyl N, Smith M, Odendaal H
Departments of Paediatrics, Tygerberg Hospital and the University of Stellenbosch, Cape, South Africa.
Am J Perinatol. 1999;16(6):309-14. doi: 10.1055/s-2007-993877.
The aim of this study was to determine the prevalence of necrotizing enterocolitis (NEC) in infants born to a homogeneous group of women with severe preeclampsia before 34 weeks' gestation and who had absent end-diastolic umbilical artery Doppler flow (AEDF) or normal umbilical Doppler flow velocities (NUFV). A total of 242 infants were entered into the study. The mean birth weight was 1260.5 g (SD = 339) and the mean gestational age 30.5 weeks (SD = 2.0). Sixty-eight (28%) infants had AEDF, 43 (18%) had umbilical artery Doppler flow velocities between the 95th and 99th percentile, and 131 (54%) had NUFV. Forty-one (18%) infants developed NEC, of whom 20 (8%) developed definite and advanced NEC (grade 2 and 3). Of these, 16(80%) had grade 2 and 4(20%) had grade 3. Twenty-one (8%) infants developed suspected NEC (grade 1). The mean onset of grade 1 NEC (7.2 days) occurred significantly earlier than in those with grades 2 and 3 NEC (18.7 and 23.3 days, respectively). Of the 21 infants with grade 1 NEC, 10 (48%) had AEDF and 9 (43%) had NUFV. None of the infants with grades 2 or 3 NEC had AEDF. We conclude that although chronically hypoxemic fetuses born to women with severe early onset preeclampsia and AEDF respond by redistributing blood flow to vital organs and away from the gut; the intestinal compromise is of insufficient magnitude to induce intestinal necrosis or NEC. Enteral feeding, however, should be introduced cautiously in infants with AEDF, as so-called suspected NEC developed significantly more often in these infants.
本研究的目的是确定孕周小于34周、患有重度子痫前期且脐动脉舒张末期血流缺失（AEDF）或脐动脉多普勒血流速度正常（NUFV）的一组同质女性所分娩婴儿中坏死性小肠结肠炎（NEC）的患病率。共有242名婴儿纳入本研究。平均出生体重为1260.5克（标准差=339），平均孕周为30.5周（标准差=2.0）。68名（28%）婴儿有AEDF，43名（18%）婴儿的脐动脉多普勒血流速度处于第95至99百分位数之间，131名（54%）婴儿有NUFV。41名（18%）婴儿发生了NEC，其中20名（8%）发生了明确的进展期NEC（2级和3级）。其中，16名（80%）为2级，4名（20%）为3级。21名（8%）婴儿发生了疑似NEC（1级）。1级NEC的平均发病时间（7.2天）明显早于2级和3级NEC的发病时间（分别为18.7天和23.3天）。在21名1级NEC婴儿中，10名（48%）有AEDF，9名（43%）有NUFV。2级或3级NEC婴儿均无AEDF。我们得出结论，虽然重度早发型子痫前期且有AEDF的女性所分娩的慢性低氧胎儿会通过将血流重新分配至重要器官而远离肠道来做出反应；但肠道受损程度不足以诱发肠道坏死或NEC。然而，对于有AEDF的婴儿，应谨慎引入肠内喂养，因为这些婴儿中所谓的疑似NEC发生得更为频繁。
