NEC 相关败血症对早产儿结局的临床影响。
Clinical impact of NEC-associated sepsis on outcomes in preterm infants.
机构信息
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
Pediatr Res. 2022 Dec;92(6):1705-1715. doi: 10.1038/s41390-022-02034-7. Epub 2022 Mar 28.
OBJECTIVE
To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.
METHODS
A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).
RESULTS
A total of 209 infants with medical (n = 98) and surgical NEC (n = 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NEC-associated sepsis had lower median GA (26.4 vs. 27.4 weeks; p = 0.01), lower birth weight (745 vs. 930 g; p = 0.009), were more likely mechanically ventilated [p < 0.001], received dopamine [p < 0.001], had more evidence of acute kidney injury [60% vs. 38.4%, p = 0.01], longer postoperative ileus (16 [13.0; 22.0] vs. 12 [8; 16] days; p = 0.006), higher levels of C-reactive protein, lower platelet counts, longer hospitalization compared to infants without NEC-associated sepsis. On multivariate regression, cholestasis was an independent risk factor for NEC-associated sepsis (OR 2.94; 95% CI 1.1-8.8, p = 0.038).
CONCLUSION
NEC-associated sepsis was associated with greater hemodynamic support, acute kidney injury, longer postoperative ileus, and hospitalization on bivariate analysis, and cholestasis was associated with higher odds of sepsis on multi regression analysis.
IMPACT
NEC-associated sepsis was present in 24% of infants with NEC. Gram-positive bacteria, Gram-negative bacteria, and Candida were found in 15.3%, 10.5%, and 2.8% of cases, respectively. Infants with NEC-associated sepsis had a greater inflammatory response (CRP levels), received more blood transfusion before NEC onset, frequently needed assisted ventilation ionotropic support, and had acute kidney injury after NEC onset. NEC infants with Gram-negative sepsis had higher portal venous gas, received more platelet transfusions before NEC onset, and had higher CRP levels and lower median lymphocyte counts at 24 h after NEC onset than those with Gram-positive sepsis.
目的
确定与坏死性小肠结肠炎（NEC）相关的败血症在患有 NEC 的婴儿中的危险因素和结局。
方法
对患有和不患有 NEC 相关败血症（定义为 NEC 发病时血培养阳性）的婴儿进行回顾性比较，比较其人口统计学和临床信息。
结果
共有 209 名患有医学性（n=98）和外科性 NEC（n=111）的婴儿，中位胎龄为 27 周（IQR 25；30.5），中位出生体重为 910g [IQR 655；1138]。209 例患儿中有 50 例（23.9%）发生 NEC 相关败血症。患有 NEC 相关败血症的婴儿胎龄更低（26.4 周 vs. 27.4 周；p=0.01），出生体重更低（745g vs. 930g；p=0.009），更有可能接受机械通气（p<0.001），接受多巴胺（p<0.001），急性肾损伤证据更多（60% vs. 38.4%，p=0.01），术后肠麻痹时间更长（16[13.0；22.0]天 vs. 12[8；16]天；p=0.006），C 反应蛋白水平更高，血小板计数更低，住院时间更长。多变量回归分析显示，胆汁淤积是 NEC 相关败血症的独立危险因素（OR 2.94；95%CI 1.1-8.8，p=0.038）。
结论
在双变量分析中，NEC 相关败血症与更大的血流动力学支持、急性肾损伤、更长的术后肠麻痹和住院时间有关，多变量回归分析显示胆汁淤积与败血症的可能性更高有关。
影响
NEC 相关败血症在 24%的 NEC 患儿中存在。革兰阳性菌、革兰阴性菌和念珠菌的检出率分别为 15.3%、10.5%和 2.8%。患有 NEC 相关败血症的婴儿炎症反应更大（CRP 水平），在 NEC 发病前接受更多输血，经常需要辅助通气和正性肌力支持，在 NEC 发病后发生急性肾损伤。患有革兰阴性菌败血症的 NEC 婴儿门静脉积气更高，在 NEC 发病前接受更多血小板输注，在 NEC 发病后 24 小时 CRP 水平更高，淋巴细胞计数中位数更低。
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