Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA.
Vermont Oxford Network, Burlington, VT, USA.
J Pediatr Surg. 2022 Jun;57(6):981-985. doi: 10.1016/j.jpedsurg.2022.01.058. Epub 2022 Feb 14.
Differences in morbidities between spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) are unknown.
Prospectively collected multicenter data regarding very low birth weight (VLBW) infants 2015-2019 were analyzed. Diagnosis of SIP or NEC was laparotomy-confirmed in all patients. Multivariable regression modeling was used to assess adjusted length of stay (LOS; primary outcome) and adjusted risk ratios (ARR) for weight <10th percentile at discharge, and supplemental oxygen requirement at discharge.
Of 201,300 VLBW infants at 790 hospitals, 1523 had SIP and 2601 had NEC. Adjusted LOS was similar for SIP and NEC (92 vs 88 days, p = 0.08561), but significantly higher than seen without SIP or NEC (68 days, p<0.0001). The risk of growth morbidity at discharge was similar between SIP and NEC (74.2% vs 75.3%; ARR:1.00;0.94,1.06), but higher than infants without SIP or NEC (47.7%; ARR:0.50;0.47,0.53). Infants with NEC were less likely to require supplemental oxygen at discharge than infants with SIP (24.4% vs 34.9%; ARR:0.80; 0.71,0.89).
Although mortality is known to be lower in VLBW infants with SIP than NEC, this study highlights the similarly high morbidity experienced by both groups of infants. These benchmark data can help align counseling of families with expected outcomes.
Level II.
Prognosis study (Cohort Study).
自发性肠穿孔（SIP）和坏死性小肠结肠炎（NEC）之间的发病率差异尚不清楚。
分析了 2015 年至 2019 年期间前瞻性收集的多中心极低出生体重（VLBW）婴儿数据。所有患者的 SIP 或 NEC 诊断均通过剖腹手术确认。多变量回归模型用于评估调整后的住院时间（LOS；主要结局）和出院时体重低于第 10 百分位、出院时需要补充氧气的调整后风险比（ARR）。
在 790 家医院的 201300 名 VLBW 婴儿中，有 1523 名患有 SIP，2601 名患有 NEC。SIP 和 NEC 的调整后 LOS 相似（92 天与 88 天，p=0.08561），但明显高于无 SIP 或 NEC 的情况（68 天，p<0.0001）。出院时生长不良的风险在 SIP 和 NEC 之间相似（74.2%与 75.3%；ARR：1.00；0.94，1.06），但高于无 SIP 或 NEC 的婴儿（47.7%；ARR：0.50；0.47，0.53）。与 SIP 患儿相比，NEC 患儿出院时需要补充氧气的可能性较低（24.4%与 34.9%；ARR：0.80；0.71，0.89）。
尽管已知 SIP 患儿的死亡率低于 NEC 患儿，但本研究强调了两组婴儿都经历了同样高的发病率。这些基准数据可以帮助指导家庭与预期结果。
二级。
预后研究（队列研究）。
