Li Xiaowen, Li Lei, Wang Yan, Deng Chun, Guo Chunbao
Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing Department of Neonatology, Jinan Maternity and Child Care Hospital, Jinan, Shandong Province Department of Neonatology, Yongchuan Hospital Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Aug;96(32):e7774. doi: 10.1097/MD.0000000000007774.
Our goal was to investigate the surgical procedures, postoperative complications, and survival with regard to different onset timing of necrotizing enterocolitis (NEC).We performed a retrospective review of medical records with a diagnosis of NEC between 2005 and 2016. The cutoff was set at 10 days for early onset ≤10 days and late onset over 10 days. Propensity score matching was performed to adjust for any baseline differences. In 53 paired patients, clinical outcomes, including, mortality, postoperative complications, and length of neonatal intensive care unit (NICU) stay, were evaluated on the basis of early or late-onset NEC.Successful 1:1 matching propensity score matching was performed with 208 infants. Mortality for early-onset NEC infants was lower than that of early late NEC infants (P = .026). A lower overall postoperative complication rate, including infectious complications [19 (35.8) vs 29 (54.7); odds ratio, 0.462, confidence interval (CI) 0.212-1.008, P = .039], was noted in patients with early-onset NEC compared with infants with late-onset NEC. NICU stay and major complication were marginal different between the 2 groups. Comparison of feeding outcomes revealed that the time to achieve full enteral feeds was significantly longer for those with late-onset NEC (18.1 ± 11.5 vs 26.3 ± 15.6, P = .008).The infants who develop NEC after 10 days of life do influence postoperative outcome survival or other clinically important outcomes after laparotomy.
我们的目标是研究坏死性小肠结肠炎(NEC)不同发病时间的手术方式、术后并发症及生存率。我们对2005年至2016年期间诊断为NEC的病历进行了回顾性研究。将发病≤10天定义为早发型,发病超过10天定义为晚发型。采用倾向得分匹配法来调整任何基线差异。在53对配对患者中,根据早发型或晚发型NEC评估临床结局,包括死亡率、术后并发症及新生儿重症监护病房(NICU)住院时间。对208例婴儿进行了成功的1:1倾向得分匹配。早发型NEC婴儿的死亡率低于晚发型NEC婴儿(P = 0.026)。与晚发型NEC婴儿相比,早发型NEC患者的总体术后并发症发生率较低,包括感染性并发症[19例(35.8%)对29例(54.7%);优势比为0.462,置信区间(CI)为0.212 - 1.008,P = 0.039]。两组之间NICU住院时间和主要并发症差异不显著。喂养结局比较显示,晚发型NEC患儿达到完全肠内喂养的时间明显更长(18.1 ± 11.5天对26.3 ± 15.6天,P = 0.008)。出生10天后发生NEC的婴儿确实会影响剖腹手术后的生存结局或其他临床重要结局。