Schulzke Sven M, Deshpande Girish C, Patole Sanjay K
Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, 374 Bagot Rd, Subiaco, Perth, Western Australia 6008, Australia.
Arch Pediatr Adolesc Med. 2007 Jun;161(6):583-90. doi: 10.1001/archpedi.161.6.583.
To systematically review observational studies reporting long-term neurodevelopmental outcomes in very low-birth-weight neonates surviving after necrotizing enterocolitis (NEC).
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health), and proceedings of the Pediatric Academic Societies (published in Pediatric Research since 1970) were searched in June and September 2006. The reference lists of identified studies and personal files were searched.
All studies with a control group were eligible for inclusion. MAIN OUTCOME EXPOSURE: Necrotizing enterocolitis (stage II or higher) vs no NEC.
Neurodevelopmental impairment at 1 year or older of corrected age.
Eleven nonrandomized studies, including 5 with "matched controls," were included in the analyses. The risk of long-term neurodevelopmental impairment was significantly higher in the presence of at least stage II NEC vs no NEC (odds ratio, 1.82; 95% confidence interval, 1.46-2.27). Significant heterogeneity (I2 = 47.9%; P = .06) between the studies indicated variations in patient, illness, and intervention characteristics and in follow-up methods. Patients with NEC requiring surgery were at higher risk for neurodevelopmental impairment vs those managed medically (odds ratio, 1.99; 95% confidence interval, 1.26-3.14). Results of analyses based on study design, follow-up rate, and year of birth were not statistically significantly different from those of the overall analysis. Risk of cerebral palsy and cognitive and severe visual impairment was significantly higher in neonates with NEC.
Survivors of stage II or higher NEC are at risk for long-term neurodevelopmental impairment, especially if they require surgery for the illness.
系统评价关于坏死性小肠结肠炎（NEC）后存活的极低出生体重儿长期神经发育结局的观察性研究。
2006年6月和9月检索了Cochrane对照试验中央登记册、MEDLINE、EMBASE、CINAHL（护理学与健康相关学科累积索引）以及儿科学术协会会议记录（自1970年起发表于《儿科学研究》）。检索了纳入研究的参考文献列表和个人文件。
所有设有对照组的研究均符合纳入标准。主要结局暴露因素：坏死性小肠结肠炎（II期或更高分期）与无NEC。
矫正年龄1岁及以上时的神经发育障碍。
分析纳入了11项非随机研究，其中5项设有“匹配对照组”。存在至少II期NEC的患儿与无NEC的患儿相比，长期神经发育障碍风险显著更高（优势比，1.82；95%置信区间，1.46 - 2.27）。研究间存在显著异质性（I² = 47.9%；P = 0.06），表明患者、疾病和干预特征以及随访方法存在差异。与接受内科治疗的患儿相比，因NEC需要手术的患儿发生神经发育障碍的风险更高（优势比，1.99；95%置信区间，1.26 - 3.14）。基于研究设计、随访率和出生年份的分析结果与总体分析结果在统计学上无显著差异。NEC患儿发生脑瘫、认知和严重视力损害的风险显著更高。
II期或更高分期NEC的存活者存在长期神经发育障碍风险，尤其是那些因该病需要手术的患儿。
