Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Foothills Hospital, University of Calgary, Calgary, AB, Canada.
J Perinatol. 2015 Aug;35(8):595-600. doi: 10.1038/jp.2015.41. Epub 2015 Apr 30.
To compare neonatal outcomes of preterm infants (born at <32 weeks' gestation) with focal/spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC)-related perforation, NEC without perforation or no NEC/perforation.
Retrospective cohort study of 17,426 infants admitted to Canadian neonatal intensive care units during 2010 to 2013. The primary outcome was a composite of mortality or morbidity (bronchopulmonary dysplasia, severe retinopathy, periventricular leukomalacia or nosocomial infection). Association of intestinal perforation with neonatal outcome was evaluated using multivariate logistic regression.
SIP was present in 178 (1.0%) infants, NEC-related perforation in 246 (1.4%) and NEC without perforation in 538 (3.1%). Any intestinal perforation was associated with higher odds of the composite outcome (adjusted odds ratio (AOR): 8.21, 95% confidence interval (95% CI) 6.26 to 10.8); however, the odds were significantly lower for focal/SIP compared with NEC-related perforation (AOR: 0.29, 95% CI 0.17 to 0.51).
Of the two types of intestinal perforation, NEC-related perforation was associated with the highest risk of an adverse neonatal outcome.
比较有局灶性/自发性肠穿孔（SIP）、与坏死性小肠结肠炎（NEC）相关穿孔、无 NEC 穿孔或无 NEC/穿孔的早产儿（<32 周出生）的新生儿结局。
对 2010 年至 2013 年期间在加拿大新生儿重症监护病房住院的 17426 名婴儿进行回顾性队列研究。主要结局是死亡率或发病率（支气管肺发育不良、严重视网膜病变、脑室周围白质软化或医院感染）的复合结局。使用多变量逻辑回归评估肠穿孔与新生儿结局的关联。
178 名（1.0%）婴儿存在 SIP，246 名（1.4%）存在与 NEC 相关的穿孔，538 名（3.1%）存在无 NEC 穿孔。任何肠穿孔均与复合结局的可能性更高相关（校正比值比（AOR）：8.21，95%置信区间（95%CI）为 6.26 至 10.8）；然而，与与 NEC 相关的穿孔相比，局灶性/SIP 的可能性明显降低（AOR：0.29，95%CI 0.17 至 0.51）。
在这两种类型的肠穿孔中，与 NEC 相关的穿孔与不良新生儿结局的风险最高。
