Vongbhavit K, Underwood M A
Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon-Nayok, Thailand.
Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
J Neonatal Perinatal Med. 2017;10(3):281-289. doi: 10.3233/NPM-16148.
To compare demographic data, prenatal and postnatal characteristics, laboratory data, and outcomes in a cohort of premature infants with spontaneous ileal perforation (SIP), surgical necrotizing enterocolitis (sNEC) and matched controls.
A retrospective case-control study of infants with intestinal perforation with a birth weight (BW) less than 2,000 grams and gestational age (GA) less than 34 weeks and infants without perforation matched for BW (±150 grams) and GA (±1week).
130 premature infants were included, 30 infants with SIP, 35 infants with sNEC and 65 control infants. The median age of onset was 5 days postnatal age in SIP versus 25 days in sNEC (p < 0.001) and the peak onset was at 26 weeks corrected GA for SIP and 30 weeks corrected GA for sNEC. Infants with perforation had significantly higher rates of mortality (p < 0.001) and common morbidities associated with prematurity. Administration of corticosteroids and indomethacin did not differ among groups. SIP was more common among infants born to young mothers (p = 0.04) and less common in infants receiving caffeine (p = 0.02). sNEC was less common among infants receiving early red cell transfusion (p = 0.01). Perforation and sNEC trended towards less common in infants receiving inhaled nitric oxide.
SIP and sNEC are distinct clinical entities. Potential protective effects of caffeine, inhaled nitric oxide, and early transfusion should be further studied.
比较一组自发性回肠穿孔（SIP）、外科坏死性小肠结肠炎（sNEC）的早产儿与匹配对照组的人口统计学数据、产前和产后特征、实验室数据及结局。
一项回顾性病例对照研究，纳入出生体重（BW）小于2000克且胎龄（GA）小于34周的肠穿孔婴儿，以及BW（±150克）和GA（±1周）匹配的无穿孔婴儿。
共纳入130例早产儿，30例SIP婴儿，35例sNEC婴儿和65例对照婴儿。SIP的中位发病年龄为出生后5天，而sNEC为25天（p<0.001），SIP的发病高峰在矫正胎龄26周，sNEC在矫正胎龄30周。穿孔婴儿的死亡率（p<0.001）和与早产相关的常见发病率显著更高。各组间皮质类固醇和吲哚美辛的使用无差异。SIP在年轻母亲所生婴儿中更常见（p=0.04），在接受咖啡因治疗的婴儿中较少见（p=0.02）。sNEC在接受早期红细胞输血的婴儿中较少见（p=0.01）。穿孔和sNEC在接受吸入一氧化氮治疗的婴儿中似乎较少见。
SIP和sNEC是不同的临床实体。咖啡因、吸入一氧化氮和早期输血的潜在保护作用应进一步研究。
