Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
University of Vermont and Vermont Oxford Network, Burlington, VT, USA.
J Pediatr Surg. 2020 Jun;55(6):998-1001. doi: 10.1016/j.jpedsurg.2020.02.046. Epub 2020 Feb 29.
We sought to describe changes in the incidence and mortality of necrotizing enterocolitis (NEC) and associated surgical management strategies for very low birth weight (VLBW) infants.
Data were prospectively collected on VLBW infants (≤1500 g or < 29 weeks) born 2006 to 2017 and admitted to 820 U.S. centers. NEC was defined by the presence of at least one clinical and one radiographic finding. Trends analyses were performed to assess changes in incidence and mortality over time.
Of 473,895 VLBW infants, 36,130 (7.6%) were diagnosed with NEC, of which 21,051 (58.3%) had medical NEC and 15,079 (41.7%) had surgical NEC. Medical NEC decreased from 5.3% to 3.0% (p < 0.0001). Surgical NEC decreased from 3.4% to 3.1% (p = 0.06). Medical NEC mortality decreased from 20.7% to 16.8% (p = 0.003), while surgical NEC mortality decreased from 36.6% to 31.6% (p < 0.0001). In the surgical cohort, the use of primary peritoneal drainage (PPD) versus initial laparotomy rose from 23.2% to 46.8%.
The incidence and mortality of both medical and surgical NEC have decreased over time. Changes in surgical management during this time period included the increased utilization of primary peritoneal drainage.
Prognosis study.
Level II.
我们旨在描述新生儿坏死性小肠结肠炎（NEC）的发病率和死亡率变化，以及极低出生体重（VLBW）儿的相关外科治疗策略。
前瞻性收集了 2006 年至 2017 年间出生于美国 820 个中心、体重≤1500g 或胎龄<29 周的 VLBW 婴儿的数据。NEC 的定义为至少有一个临床和一个影像学表现。进行趋势分析以评估发病率和死亡率随时间的变化。
在 473895 例 VLBW 婴儿中，36130 例（7.6%）被诊断为 NEC，其中 21051 例（58.3%）为内科性 NEC，15079 例（41.7%）为外科性 NEC。内科性 NEC 从 5.3%降至 3.0%（p<0.0001）。外科性 NEC 从 3.4%降至 3.1%（p=0.06）。内科性 NEC 的死亡率从 20.7%降至 16.8%（p=0.003），而外科性 NEC 的死亡率从 36.6%降至 31.6%（p<0.0001）。在外科组中，与初次剖腹术相比，初始使用腹膜灌洗引流（PPD）的比例从 23.2%上升至 46.8%。
内科性和外科性 NEC 的发病率和死亡率随时间推移而下降。在此期间，外科治疗策略的变化包括腹膜灌洗引流使用率的增加。
预后研究。
II 级。
