Hayakawa Masahiro, Taguchi Tomoaki, Urushihara Naoto, Yokoi Akiko, Take Hiroshi, Shiraishi Jun, Fujinaga Hideshi, Ohashi Kensuke, Oshiro Makoto, Kato Yuichi, Ohfuji Satoko, Okuyama Hiroomi
Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Pediatr Int. 2015 Aug;57(4):633-8. doi: 10.1111/ped.12594. Epub 2015 May 6.
Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age.
A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated.
The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age.
NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
外科性肠道疾病，如坏死性小肠结肠炎（NEC）、局灶性肠穿孔（FIP）和胎粪性肠梗阻（MRI），是极低出生体重儿（VLBWI）的严重发病情况。本研究的目的是比较患有外科性肠道疾病的极低出生体重儿的死亡或神经发育障碍（NDI）复合结局，并评估矫正年龄18个月时死亡和NDI的独立危险因素。
在11家机构进行了一项回顾性匹配队列研究。我们纳入了因NEC、FIP和MRI接受剖腹手术的极低出生体重儿。为每位手术患儿选择两名对照受试者，并根据胎龄和出生体重进行匹配以形成比较组。评估矫正年龄18个月时的死亡和神经发育结局。
NEC组、FIP组、MRI组和对照组的婴儿数量分别为44例、47例、42例和261例。NEC和MRI患儿的院内死亡率高于对照组（P<0.001）。矫正年龄18个月时，MRI患儿的NDI发生率高于对照组（P=0.021）。逻辑回归分析显示，低胎龄、男性、小于胎龄、脑室内出血和MRI与矫正年龄18个月时死亡或NDI风险增加相关。
NEC和MRI与院内死亡率相关，MRI与矫正年龄18个月时的NDI或死亡相关。
