Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Hutzel Women’s Hospital, Detroit, Michigan 48201, USA.
Pediatrics. 2011 Jul;128(1):e54-62. doi: 10.1542/peds.2011-0265. Epub 2011 Jun 20.
Postnatal indomethacin is reportedly associated with an increased incidence of necrotizing enterocolitis (NEC) in preterm infants. Because indomethacin readily crosses the placenta, we hypothesized that antenatal indomethacin (AI) would increase the risk for NEC in preterm infants.
The goal of this study was to explore the association between AI and NEC in preterm infants.
Medical records of preterm infants, 23 to 32 weeks' gestational age, without major congenital anomalies, were reviewed. Maternal and neonatal data were abstracted. Association of AI within 15 days before delivery (predictor variable) and classification of NEC according to modified Bell's stage 2a or higher in the first 15 days after delivery (early NEC [primary outcome variable]) was explored by using bivariate analyses, multivariate logistic regression, and propensity score analysis.
Of 628 eligible infants, 63 received AI and 28 developed early NEC. AI exposure was significantly associated with multiple gestation, race, antenatal corticosteroids and magnesium sulfate, lower birth weight and gestational age, umbilical arterial catheter placement, respiratory distress syndrome, postnatal vasopressors and antibiotics, patent ductus arteriosus, sepsis, NEC, intraventricular hemorrhage, and mortality. On multivariate logistic regression controlling for covariates, AI was significantly associated with early NEC (adjusted odds ratio: 7.193 [95% confidence interval: 2.514-20.575]; number needed to harm: 5). The results remained significant when analyses were repeated using AI exposure within 5 days before delivery as a predictor variable; on analyses stratified according to gestational age; and on propensity score analysis.
AI was associated with NEC in preterm infants in the first 15 days of life in this study, as were multiple other clinical factors.
据报道，产后使用吲哚美辛会增加早产儿患坏死性小肠结肠炎（NEC）的风险。由于吲哚美辛很容易穿过胎盘，我们假设产前使用吲哚美辛（AI）会增加早产儿患 NEC 的风险。
本研究旨在探讨 AI 与早产儿 NEC 之间的关系。
回顾了胎龄 23 至 32 周、无重大先天畸形的早产儿的病历。提取了母婴数据。通过双变量分析、多变量逻辑回归和倾向评分分析，探讨了分娩前 15 天内使用 AI（预测变量）与分娩后 15 天内发生改良 Bell 分期 2a 级或更高的 NEC（早期 NEC [主要结局变量]）之间的关系。
在 628 名符合条件的婴儿中，有 63 名接受了 AI 治疗，有 28 名婴儿发生了早期 NEC。AI 暴露与多胎妊娠、种族、产前皮质激素和硫酸镁、出生体重和胎龄较低、脐动脉导管放置、呼吸窘迫综合征、产后血管加压素和抗生素、动脉导管未闭、败血症、NEC、颅内出血和死亡率显著相关。在控制协变量的多变量逻辑回归中，AI 与早期 NEC 显著相关（调整后的优势比：7.193 [95%置信区间：2.514-20.575]；需要治疗的人数：5）。当将 AI 暴露作为预测变量，将分析范围缩小到分娩前 5 天内时，当根据胎龄分层进行分析时，以及在倾向评分分析中，结果仍然显著。
在本研究中，AI 与早产儿出生后 15 天内的 NEC 相关，还有许多其他临床因素也与 NEC 相关。
