Elfvin Anders, Dinsdale Elsa, Wales Paul W, Moore Aideen M
Divisions of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Acta Paediatr. 2015 Aug;104(8):771-6. doi: 10.1111/apa.12997. Epub 2015 Apr 13.
Necrotising enterocolitis (NEC) is associated with high morbidity and mortality. The aim of this study was to identify predictors of intestinal failure (IF), morbidity and mortality following NEC.
We performed a retrospective study of all neonates treated for NEC stage II or greater at a tertiary referral NICU between 2000 and 2009. Demographic data, need for surgery, residual bowel length and rates of bacteraemia, cholestasis, IF and mortality were analysed.
During the 10-year period, 301 patients were referred with NEC and 152 had surgical intervention. Overall mortality was 32%. Of the 230 infants who survived >42 days, 97 (42%) had IF at 42 days, decreasing to 15% at >90 days. The rate of IF was significantly higher in the surgical group than the medical group (OR 2.04, 95% CI, 1.25-3.35, p < 0.004), but 23% of the medically treated infants with NEC also developed IF. There was a significant relationship between IF and gram-negative bacteraemia, the need for surgery, cholestasis, liver failure and mortality.
Intestinal failure occurred in a significant proportion of infants with NEC. Predictors for IF among infants with NEC were low birthweight, low gestational age, need for surgical intervention and gram-negative bacteraemia.
坏死性小肠结肠炎（NEC）与高发病率和死亡率相关。本研究的目的是确定NEC后肠衰竭（IF）、发病率和死亡率的预测因素。
我们对2000年至2009年期间在一家三级转诊新生儿重症监护病房接受II期或更严重NEC治疗的所有新生儿进行了回顾性研究。分析了人口统计学数据、手术需求、残余肠长度以及菌血症、胆汁淤积、IF和死亡率。
在这10年期间，301例患者因NEC转诊，152例接受了手术干预。总体死亡率为32%。在存活超过42天的230例婴儿中，97例（42%）在42天时出现IF，在超过90天时降至15%。手术组的IF发生率显著高于非手术组（OR 2.04，95%CI，1.25 - 3.35，p < 0.004），但23%接受非手术治疗的NEC婴儿也出现了IF。IF与革兰氏阴性菌血症、手术需求、胆汁淤积、肝功能衰竭和死亡率之间存在显著关系。
相当比例的NEC婴儿发生了肠衰竭。NEC婴儿中IF的预测因素为低出生体重、低胎龄、手术干预需求和革兰氏阴性菌血症。
