临床结局与基于胎龄的预测对坏死性小肠结肠炎早产儿的肠气肿。
Clinical outcomes and gestational age based prediction of pneumatosis intestinalis in preterm infants with necrotizing enterocolitis.
机构信息
Department of Pediatrics/Neonatology, University of Mississippi, Jackson, MS, USA.
Department of Data Science, University of Mississippi, Jackson, MS, USA.
出版信息
J Neonatal Perinatal Med. 2022;15(4):803-812. doi: 10.3233/NPM-210971.
BACKGROUND
To determine the clinical implications and gestation age-specific diagnostic predictability of pneumatosis in preterm infants with necrotizing enterocolitis (NEC).
METHODS
A retrospective study on abdominal radiographs comparing clinical and radiological information in infants with and without pneumatosis.
RESULT
Our findings disproved our hypothesis. Pneumatosis was seen more frequently in infants with higher gestational age [28.4 (26.1-32.4) vs. 26.4 (24.3-29) weeks; p < 0.001] and birth weight [1110 (762-1768) vs. 770 (645-1022) grams; p < 0.001] and were more likely delivered vaginally (39.1% vs. 21.7%, p = 0.01). Portal venous gas was seen frequently on radiographs (10.3% vs. 0%, p < 0.001), but not pneumoperitoneum (20.7% vs. 36.7%, p = 0.02). Infants with pneumatosis frequently developed acute kidney injury, with higher serum creatinine (16.5% vs. 4.5%, p = 0.02) and frequent oliguria (12.9% vs. 2.7 %; p = 0.043) and had higher C-reactive protein levels at 24 and 96 hours (p < 0.002). Receiver operating curves for pneumatosis showed GA >28 weeks and birth weight > 1000 gm to have a sensitivity of 58.6% and specificity of 72.5%.
CONCLUSION
Contrary to our hypothesis, infants who developed pneumatosis during NEC were more mature with a higher gestational age and birth weight than those who did not.
背景
为了确定患有坏死性小肠结肠炎（NEC）的早产儿中肠气肿的临床意义和与胎龄相关的诊断预测性。
方法
回顾性研究比较了有和无肠气肿的婴儿的腹部 X 光片的临床和影像学信息。
结果
我们的研究结果推翻了我们的假设。胎龄较高[28.4（26.1-32.4）与 26.4（24.3-29）周；p<0.001]和出生体重较高[1110（762-1768）与 770（645-1022）克；p<0.001]的婴儿更常出现肠气肿，且阴道分娩的可能性更大（39.1%与 21.7%，p=0.01）。X 光片上常可见门静脉积气（10.3%与 0%，p<0.001），但无气腹（20.7%与 36.7%，p=0.02）。有肠气肿的婴儿常发生急性肾损伤，血清肌酐水平更高（16.5%与 4.5%，p=0.02），少尿更常见（12.9%与 2.7%；p=0.043），且 24 小时和 96 小时的 C 反应蛋白水平更高（p<0.002）。肠气肿的受试者工作特征曲线显示，GA>28 周和 BW>1000 克的敏感性为 58.6%，特异性为 72.5%。
结论
与我们的假设相反，患有 NEC 的肠气肿婴儿比未患有肠气肿的婴儿更为成熟，胎龄和出生体重更高。
Zotero 插件