Suply Etienne, Leclair Marc-David, Neunlist Michel, Roze Jean-Christophe, Flamant Cyril
Department of Chirurgie Pédiatrique, CHU Nantes, Nantes, France.
Institut des Maladies de l'Appareil Digestif DHU 2020, INSERM U913, Nantes, France.
Eur J Pediatr Surg. 2015 Dec;25(6):520-5. doi: 10.1055/s-0034-1396418. Epub 2015 Feb 2.
Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are serious abdominal conditions that affect preterm infants but are poorly understood. This single-center retrospective study was performed to identify the factors associated with NEC and SIP.
This study involved 3,464 preterm infants recruited over 16 years. A total of 136 NEC and 24 SIP were analyzed and adjusted odds ratios (aOR) were determined by logistic regression.
Compared with the controls, NEC was associated with a Z-score for birth weight lower than -1 (aOR = 2.1 [1.1-3.9], p = 0.02) and lower than -2 (aOR = 4.4 [1.8-10.4], p < 0.01). NEC was associated with gestational ages of less than 31 weeks and with breech presentations (aOR = 1.5 [1.0-2.3], p = 0.03). In contrast, compared with the controls, SIP was associated with gestational ages of less than 26 weeks (aOR = 17.4 [3.1-96.2], p < 0.001) and multiple pregnancy (aOR = 2.9 [1.2-6.9], p = 0.02). Rates of mortality and cerebral lesions were higher in patients with NEC (25.0 and 13.2%, respectively) than with the controls (10.1 and 6.9%, respectively) and similar between patients with SIP (12.5 and 8.3%, respectively) and the controls. CONCLUSIon: NEC and SIP differed in risk factors and prognosis. Early distinction of SIP from NEC could impact on surgical decision.
坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）是影响早产儿的严重腹部疾病，但人们对此了解甚少。本单中心回顾性研究旨在确定与NEC和SIP相关的因素。
本研究纳入了16年间招募的3464名早产儿。共分析了136例NEC和24例SIP，并通过逻辑回归确定调整后的优势比（aOR）。
与对照组相比，NEC与出生体重Z评分低于-1（aOR = 2.1 [1.1 - 3.9]，p = 0.02）以及低于-2（aOR = 4.4 [1.8 - 10.4]，p < 0.01）相关。NEC与孕龄小于31周以及臀位分娩相关（aOR = 1.5 [1.0 - 2.3]，p = 0.03）。相比之下，与对照组相比，SIP与孕龄小于26周（aOR = 17.4 [3.1 - 96.2]，p < 0.001）以及多胎妊娠相关（aOR = 2.9 [1.2 - 6.9]，p = 0.02）。NEC患者的死亡率和脑损伤发生率（分别为25.0%和13.2%）高于对照组（分别为10.1%和6.9%），SIP患者（分别为12.5%和8.3%）与对照组相似。结论：NEC和SIP在危险因素和预后方面存在差异。早期将SIP与NEC区分开来可能会影响手术决策。
