足月儿坏死性小肠结肠炎的迟发与死亡率增加相关：一项双中心分析的结果
Late onset of necrotizing enterocolitis in the full-term infant is associated with increased mortality: results from a two-center analysis.
作者信息
Short Scott S, Papillon Stephanie, Berel Dror, Ford Henri R, Frykman Philip K, Kawaguchi Akemi
机构信息
Division of Pediatric Surgery, Children's Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Pediatric Surgery, Children's Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
出版信息
J Pediatr Surg. 2014 Jun;49(6):950-3. doi: 10.1016/j.jpedsurg.2014.01.028. Epub 2014 Feb 5.
PURPOSE
The effect of timing of onset of necrotizing enterocolitis (NEC) on outcomes has not been determined for the full-term infant. In this study we aimed to characterize the full-term NEC population and to evaluate onset of NEC.
METHODS
We performed a two-center retrospective review of all full-term infants (≥ 37weeks) with a diagnosis of NEC between 1990 and 2012. Patients were identified by ICD-9 and age. Early onset for NEC was ≤7days and late onset after 7days of life. Demographics, comorbidities, maternal factors, clinical factors, surgical intervention, complications, and mortality were evaluated. Wilcoxon's test was performed on continuous variables and Fisher's exact test on categorical data. A p-value<0.05 was considered significant. Univariate outcomes with a p-value<0.1 were selected for multivariable analysis.
RESULTS
Thirty-nine patients (24 boys, 15 girls) with median EGA of 39weeks were identified. Overall mortality was 18%. Univariate predictors of mortality included congenital heart disease and placement of an umbilical artery (UA) catheter. Multivariate analysis revealed late onset of NEC to be an independent predictor of mortality (OR 90.8, 95% CI 2.6-3121).
CONCLUSION
Full-term infants who develop NEC after 7days of life, have congenital heart disease, and/or need UA catheterization have increased mortality.
目的
坏死性小肠结肠炎（NEC）发病时间对足月儿预后的影响尚未明确。在本研究中，我们旨在描述足月儿NEC患者群体并评估NEC的发病情况。
方法
我们对1990年至2012年间所有诊断为NEC的足月儿（≥37周）进行了一项双中心回顾性研究。通过国际疾病分类第九版（ICD - 9）和年龄来确定患者。NEC早发型定义为≤7天，晚发型为出生7天后发病。评估了人口统计学、合并症、母体因素、临床因素、手术干预、并发症和死亡率。对连续变量进行Wilcoxon检验，对分类数据进行Fisher精确检验。p值<0.05被认为具有统计学意义。p值<0.1的单因素结果被选入多变量分析。
结果
共确定了39例患者（24例男孩，15例女孩），中位预产期龄（EGA）为39周。总体死亡率为18%。死亡率的单因素预测因素包括先天性心脏病和脐动脉（UA）导管置入。多变量分析显示，NEC晚发型是死亡率的独立预测因素（比值比90.8，95%可信区间2.6 - 3121）。
结论
出生7天后发生NEC、患有先天性心脏病和/或需要进行脐动脉导管插入术的足月儿死亡率增加。
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