Division of Neonatology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
BMC Pediatr. 2018 May 8;18(1):155. doi: 10.1186/s12887-018-1131-x.
Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Our objective was to evaluate the impact of an umbilical cord milking protocol (UCM) and pasteurized donor human milk (PDHM) on NEC rates in infants less than 30 weeks gestational age from January 1, 2010 to September 30, 2016. We hypothesized an incremental decrease in NEC after each intervention.
We performed a retrospective review of 638 infants born less than 30 weeks gestational age. Infants were grouped into three epochs: pre-UCM/pre-PDHM (Epoch 1, n = 159), post-UCM/pre-PDHM (Epoch 2, n = 133), and post-UCM/post-PDHM (Epoch 3, n = 252). The incidence of NEC, surgical NEC, and NEC/death were compared. Logistic regression was used to determine independent significance of time epoch, gestational age, birth weight, and patent ductus arteriosus for NEC, surgical NEC, and death/NEC.
At birth, infants in Epoch 1 were younger than Epoch 2 and 3 (26.8 weeks versus 27.3 and 27.2, respectively, P = 0.036) and smaller (910 g versus 1012 and 983, respectively, P = 0.012). Across epochs, there was a significant correlation between patent ductus arteriosus treatment and NEC rate (P < 0.001, Cochran-Mantel-Haenszel). There was a significant decrease in rates of NEC, surgical NEC, and NEC/death between groups. Logistic regression showed this as significant for rates of NEC and surgical NEC between Epoch 1 and 3. Patent ductus arteriosus was a significant variable affecting the incidence of NEC, but not surgical NEC or death/NEC.
An umbilical cord milking protocol and pasteurized donor human milk availability was associated with decreased rates of NEC and surgical NEC. This suggests an additive effect of these interventions in preventing NEC.
坏死性小肠结肠炎（NEC）是早产儿的严重并发症。我们的目的是评估脐带挤奶方案（UCM）和巴氏消毒供体人乳（PDHM）对 2010 年 1 月 1 日至 2016 年 9 月 30 日之间小于 30 周胎龄婴儿 NEC 发生率的影响。我们假设每次干预后 NEC 的发生率都会逐渐降低。
我们对 638 名小于 30 周胎龄的婴儿进行了回顾性研究。将婴儿分为三个时期：UCM/PDHM 前（第 1 期，n=159）、UCM/PDHM 后（第 2 期，n=133）和 UCM/PDHM 后（第 3 期，n=252）。比较 NEC、手术 NEC 和 NEC/死亡的发生率。采用逻辑回归确定时间期、胎龄、出生体重和动脉导管未闭对 NEC、手术 NEC 和死亡/NEC 的独立意义。
出生时，第 1 期婴儿比第 2 期和第 3 期婴儿小（26.8 周比 27.3 周和 27.2 周，P=0.036），体重也较轻（910 克比 1012 克和 983 克，P=0.012）。在各时期之间，动脉导管未闭的治疗与 NEC 发生率之间存在显著相关性（P<0.001，Cochran-Mantel-Haenszel）。NEC、手术 NEC 和 NEC/死亡的发生率在各组之间均有显著下降。逻辑回归显示，第 1 期和第 3 期之间 NEC 和手术 NEC 的发生率存在显著差异。动脉导管未闭是影响 NEC 发生率的重要变量，但不影响手术 NEC 或死亡/NEC。
脐带挤奶方案和巴氏消毒供体人乳的应用与 NEC 和手术 NEC 发生率的降低有关。这表明这些干预措施在预防 NEC 方面具有附加作用。
