Garg Parvesh M, Paschal Jaslyn L, Lett Katherine, Middleton Charles, Varshney Neha, Maheshwari Akhil
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.
Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.
Newborn (Clarksville). 2022 Jan-Mar;1(1):14-26. doi: 10.5005/jp-journals-11002-0024. Epub 2022 Mar 31.
The prognosis in surgical necrotizing enterocolitis (NEC) has focused on the total length of the resected bowel; the relative impact of small intestinal vs colonic resection is not well studied.
We hypothesized that intestinal resections may reduce mortality and length of hospital stay (LOS) more likely in infants who have NEC extending into the colon than in those with disease limited to the small intestine. We also investigated the relationship between gestational maturation and NEC-related mortality.
A retrospective study of 153 patients compared demographic, clinical, and histopathological information in infants who had NEC limited to the small intestine vs disease with colonic involvement.
Our 153 infants had a mean (±standard deviation) gestational age of 27.4 ± 3.4 weeks and a birth weight of 987 ± 505 g. NEC was limited to the small intestine in 103 (67.3%) infants and extended into the colon in 50 (32.7%). Infants with small intestinal NEC needed shorter bowel resections of 28 ± 31.9 cm than 42.2 ± 40.7 cm in those with colonic involvement ( = 0.02). The LOS was longer in NEC limited to the small intestine than in disease with colonic lesions (96 ± 88.1 vs 69.7 ± 19.1 days; <0.05). In small intestinal NEC, mortality decreased to <50% beyond a gestational age (GA) >37 weeks. In contrast, infants with NEC that involved the colon had mortality <50% mortality beyond 27.3 weeks' GA ( = 0.008).
Bowel resections may be more likely associated with shorter LOS in surgical NEC that involves both the small bowel and colon, even when longer segments of the gastrointestinal tract are removed, than in disease limited to the small intestine.
外科坏死性小肠结肠炎（NEC）的预后主要关注切除肠段的总长度；小肠切除术与结肠切除术的相对影响尚未得到充分研究。
我们假设，与疾病局限于小肠的婴儿相比，患有NEC且病变累及结肠的婴儿进行肠道切除术更有可能降低死亡率和缩短住院时间（LOS）。我们还研究了胎龄成熟度与NEC相关死亡率之间的关系。
一项对153例患者的回顾性研究比较了NEC局限于小肠的婴儿与病变累及结肠的婴儿的人口统计学、临床和组织病理学信息。
我们的153例婴儿平均（±标准差）胎龄为27.4±3.4周，出生体重为987±505克。103例（67.3%）婴儿的NEC局限于小肠，50例（32.7%）婴儿的病变累及结肠。小肠NEC婴儿所需的肠切除长度为28±31.9厘米，短于病变累及结肠的婴儿的42.2±40.7厘米（P = 0.02）。局限于小肠的NEC患者的住院时间长于病变累及结肠的患者（96±88.1天对69.7±19.1天；P<0.05）。在小肠NEC中，胎龄（GA）>37周后死亡率降至<50%。相比之下，病变累及结肠的NEC婴儿在GA超过27.3周后死亡率<50%（P = 0.008）。
在涉及小肠和结肠的外科NEC中，即使切除的胃肠道段更长，肠道切除术也可能比局限于小肠的疾病更有可能缩短住院时间。
