Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 2020 Jul;105(4):432-439. doi: 10.1136/archdischild-2019-317830. Epub 2019 Dec 4.
To determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.
Systematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.
Of 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%-64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).
This study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.
CRD42019120522.
（1）确定坏死性小肠结肠炎（NEC）患儿的神经发育障碍（NDI）发生率，（2）NEC 严重程度对这些患儿 NDI 的影响，以及（3）NEC 患儿的脑损伤情况。
系统评价：三位独立研究者检索了报道有 NDI 病史的 NEC 婴儿的研究（PubMed、Medline、Cochrane 协作网、Scopus）。Meta 分析：采用 RevMan V.5.3，我们比较了 NEC 患儿与早产儿、NEC 患儿的治疗方式为内科治疗与外科治疗之间的 NDI 发生率和脑损伤类型。
在筛选出的 10674 篇摘要中，有 203 篇全文文章被审查。在 31 项研究（n=2403 例 NEC 患儿）中，NDI 发生率为 40%（28%~64%），外科治疗的 NEC 患儿（43%）高于内科治疗的 NEC 患儿（27%，p<0.00001）。NEC 患儿最常见的 NDI 为脑瘫（18%）。脑损伤：NEC 患儿的脑室周围出血（IVH）（26%）多于早产儿（18%；p<0.0001）。外科治疗的 NEC 患儿（25%）与内科治疗的 NEC 患儿（20%）的 IVH 发生率无差异（p=0.4）。NEC 患儿的脑室周围白质软化（PVL）发生率（11%）显著高于早产儿（5%；p<0.00001）。
本研究表明，很大一部分 NEC 幸存者存在 NDI。与单纯早产儿相比，NEC 患儿发生 IVH 和/或 PVL 的风险更高。NDI 程度似乎与肠道损伤的严重程度相关，外科治疗的 NEC 患儿比内科治疗的 NEC 患儿病情更差。
CRD42019120522。
