在现行治疗方案下，HIV 暴露并不会使 III 期坏死性小肠结肠炎的预后恶化。

HIV exposure does not worsen outcome in stage III necrotizing enterocolitis with current treatment protocols.

机构信息

Division of Paediatric Surgery University of Stellenbosch, Cape Town, South Africa.

出版信息

J Pediatr Surg. 2012 Apr;47(4):665-72. doi: 10.1016/j.jpedsurg.2011.11.047.

DOI:10.1016/j.jpedsurg.2011.11.047

Abstract

BACKGROUND/PURPOSE: The heavy burden of maternal HIV infection in developing countries such as South Africa has resulted in a high prevalence of premature birth and necrotizing enterocolitis (NEC). Uninfected infants born to HIV-infected mothers also demonstrate immune deficiencies. It is, therefore, essential to have a better understanding of how to mitigate HIV as an independent risk factor for surgically treated NEC and to evaluate the relevant contributing factors in the presence of an aggressive strategy of pasteurized breast milk feeding and antiretroviral prophylaxis.

METHODS

Infants with stage IIIb NEC presenting over a 4-year period were retrospectively reviewed. HIV-exposed infants were compared with non-HIV-exposed infants. Contributing factors were evaluated and studied by systematic statistical methods to evaluate risk.

RESULTS

Twenty percent (17/87) infants were HIV-exposed, and 80% (70/87), unexposed, whereas a further 10 (total, n = 97) had unknown HIV exposure status. Demographics and other perinatal risk factors between the 2 groups were not significantly different other than that HIV-exposed infants received pasteurized breast milk and nonexposed infants received unpasteurized breast milk. There were no statistically significant differences between the groups with respect to disease presentation or severity, surgical findings or type of surgery, postoperative complications, survival, or timing of death. Trends toward higher antenatal steroid exposure and increased postoperative sepsis in the HIV-exposed group (P = .03) were noted but were not related. All HIV-exposed infants received antiretrovirals; there were no significant differences on subanalysis between different antiretroviral regimens.

CONCLUSIONS

HIV-exposed infants do not have a more severe disease course nor more adverse outcomes in stage IIIb NEC than unexposed infants. Significant factors were antenatal steroids and post-NEC infective episodes.

摘要

背景/目的：在南非等发展中国家，母婴 HIV 感染负担沉重，导致早产和坏死性小肠结肠炎（NEC）高发。HIV 感染母亲所生的未感染婴儿也表现出免疫缺陷。因此，必须更好地了解如何减轻 HIV 作为手术治疗 NEC 的独立危险因素的影响，并在积极采用巴氏消毒母乳喂养和抗逆转录病毒预防策略的情况下，评估相关的促成因素。

方法

回顾性分析了 4 年来出现 IIIb 期 NEC 的婴儿。将 HIV 暴露婴儿与非 HIV 暴露婴儿进行比较。通过系统统计方法评估和研究促成因素，以评估风险。

结果

20%（17/87）的婴儿为 HIV 暴露，80%（70/87）为未暴露，而另外 10 名（总数 n=97）的 HIV 暴露状态未知。两组之间的人口统计学和其他围产期危险因素除了 HIV 暴露婴儿接受巴氏消毒母乳而未暴露婴儿接受未巴氏消毒母乳外，并无显著差异。两组在疾病表现或严重程度、手术发现或手术类型、术后并发症、存活率或死亡时间方面无统计学差异。在 HIV 暴露组中，产前类固醇暴露和术后脓毒症增加的趋势较高（P=0.03），但无统计学意义。所有 HIV 暴露婴儿均接受抗逆转录病毒治疗；亚组分析显示，不同抗逆转录病毒方案之间无显著差异。