Zhang Han, Chen Jiaping, Wang Yan, Deng Chun, Li Lei, Guo Chunbao
Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing Department of Neonatology, Jinan Maternity and Child Care Hospital, Shandong Province Department of Neonatology, Yongchuan Hospital, Chongqing Medical University Department of Pediatric Surgery, Sanxia Hospital, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Mar;96(10):e6273. doi: 10.1097/MD.0000000000006273.
Intestinal stricture is a severe and common complication of necrotizing enterocolitis (NEC), causing severe and prolonged morbidity. Our goal was to investigate the clinical predictors for strictures developing after NEC and evaluate the management outcome of the post-NEC strictures to better orient their medicosurgical care.A total of 188 patients diagnosed with NEC with identical treatment protocols throughout the period under study were retrospectively reviewed from 4 academic neonatal centers between from January 1, 2011, and October 31, 2016. Clinical predictive factors and clinical outcomes, including demographic information, clinical management, laboratory data, histopathology of resected bowel segment, and discharge summaries, were evaluated on the basis of with post-NEC strictures or not.Of the involved variables examined, the late-onset NEC [risk ratio (RR), 0.56; 95% confidence interval (95% CI), 0.41-0.92; P < 0.001], cesarean delivery (RR, 1.42; 95% CI, 0.98-2.29; P = 0.026), and first procalcitonin (PCT) (onset of symptoms) (RR, 1.82; 95% CI, 0.98-3.15; P = 0.009) were the independent predictive factors for the post-NEC strictures. C-reactive protein (CRP), white blood cell (WBC), and plateletcrit levels were markedly higher on infants with stricture and elevated levels were maintained until the stricture was healed. Infants with intestinal stricture had significantly longer times to beginning enteral feeds (23.9 ± 12.1), than infants without intestinal stricture (18.6 ± 8.8) (P = 0.023). The median age at discharge was also significantly higher in the group with stricture (P = 0.014).This retrospective and multicenter study demonstrates that the early-onset NEC and cesarean delivery conferred protection over the post-NEC stricture. Infants with post-NEC stricture need prolonged hospitalization.
肠道狭窄是坏死性小肠结肠炎（NEC）一种严重且常见的并发症，会导致严重且长期的发病情况。我们的目标是研究NEC后发生狭窄的临床预测因素，并评估NEC后狭窄的治疗效果，以便更好地指导其药物和手术治疗。在2011年1月1日至2016年10月31日期间，对来自4个学术性新生儿中心的188例诊断为NEC且在整个研究期间采用相同治疗方案的患者进行了回顾性研究。根据是否发生NEC后狭窄，对临床预测因素和临床结果进行了评估，包括人口统计学信息、临床管理、实验室数据、切除肠段的组织病理学以及出院小结。在所检查的相关变量中，迟发性NEC[风险比（RR），0.56；95%置信区间（95%CI），0.41 - 0.92；P＜0.001]、剖宫产（RR，1.42；95%CI，0.98 - 2.29；P = 0.026）以及首次降钙素原（PCT）（症状出现时）（RR，1.82；95%CI，0.98 - 3.15；P = 0.009）是NEC后狭窄的独立预测因素。狭窄婴儿的C反应蛋白（CRP）、白细胞（WBC）和血小板比容水平明显更高，且在狭窄愈合前这些水平一直维持升高。有肠道狭窄的婴儿开始肠内喂养的时间（23.9±12.1）明显长于无肠道狭窄的婴儿（18.6±8.8）（P = 0.023）。狭窄组的出院中位年龄也明显更高（P = 0.014）。这项回顾性多中心研究表明，早发性NEC和剖宫产对NEC后狭窄具有保护作用。患有NEC后狭窄的婴儿需要延长住院时间。
