Duci Miriam, Fascetti-Leon Francesco, Erculiani Marta, Priante Elena, Cavicchiolo Maria Elena, Verlato Giovanna, Gamba Piergiorgio
Division of Paediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy.
Division on Neonatal Intensive Care Unit, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy.
Pediatr Surg Int. 2018 Jun;34(6):663-669. doi: 10.1007/s00383-018-4261-1. Epub 2018 Apr 11.
Necrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify factors predisposing the development of severe forms of NEC.
This retrospective study examined NEC patients in a single centre between 2002 and 2015. Data concerning clinical characteristics, therapeutic management as well as short-term outcomes were collected. We compared the patients receiving successful medical treatment and those requiring surgical intervention. Patients who underwent surgery were distinguished in three subcategories. Bivariate and multivariate analyses were used for the statistical analysis.
We identified 155 patients in the study period. 102 were treated conservatively and 53 required surgery. 8 received a primary peritoneal drainage, 31 received a drainage and a subsequent laparotomy and 14 received a laparotomy. Multivariate regression analysis identified a lower risk for surgery with a later onset and higher serum pH values, whereas an increased risk with higher C reactive Protein (CRP) levels at the onset. Pneumatosis intestinalis was identified as a protective factor. Overall mortality was 6.4%, with higher percentage in surgical NEC.
This study suggests that a later onset is a protective sign for the progression to surgery, whereas lower pH values and higher CRP levels are prognostic factors associated with the need for surgery. The line of treatment involving explorative laparotomy in case of perforation seems to be rewarded by low morbidity and mortality rate.
坏死性小肠结肠炎（NEC）是一种严重的新生儿疾病。本研究旨在确定易导致严重形式NEC发生的因素。
这项回顾性研究对2002年至2015年间单中心的NEC患者进行了检查。收集了有关临床特征、治疗管理以及短期结局的数据。我们比较了接受成功药物治疗的患者和需要手术干预的患者。接受手术的患者分为三个亚类。采用双变量和多变量分析进行统计分析。
我们在研究期间确定了155例患者。102例接受了保守治疗，53例需要手术。8例接受了初次腹腔引流，31例接受了引流及随后的剖腹手术，14例接受了剖腹手术。多变量回归分析确定，发病较晚和血清pH值较高时手术风险较低，而发病时C反应蛋白（CRP）水平较高则风险增加。肠壁积气被确定为一个保护因素。总体死亡率为6.4%，手术治疗的NEC患者死亡率更高。
本研究表明，发病较晚是进展至手术的一个保护标志，而较低的pH值和较高的CRP水平是与手术需求相关的预后因素。在穿孔情况下采用探索性剖腹手术的治疗方法似乎具有较低的发病率和死亡率。
