Sinha Chandrasen K, Ashworth Iona, Martin Sarah, Bhayat Sadaf, Kulkarni Anay
Paediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
Neonatology, St George's University Hospitals NHS Foundation Trust, London, London, UK.
World J Pediatr Surg. 2021 Mar 18;4(1):e000246. doi: 10.1136/wjps-2020-000246. eCollection 2021.
The primary aim was to scrutinize our hypothesis: "Do more mature preterm (MMP) babies with surgical necrotizing enterocolitis (NEC) predominantly develop the colonic disease and are different in their response and behaviour in comparison to exceedingly preterm (EP) babies?" Secondary outcomes were to define time taken in developing NEC, time from diagnosis to laparotomy, requirement of parenteral nutrition (PN), and ventilatory support.
We defined MMP babies as ≥30 weeks of gestation and EP babies as ≤29 weeks of gestation. Inclusion criteria were all babies <37 weeks with NEC requiring surgery (called surgical NEC group). Data were collected retrospectively and analyzed using QuickCalcs.
Of the total, 41% (97/234) of babies underwent laparotomy between 2010 and 2019. Totally, 81% were EP and 19% were MMP babies. Pure colonic involvement was seen in 9% of EP babies in comparison to 56% in the MMP babies (p=0.0001). Involvement of only the small bowel was seen in two-thirds of EP babies in comparison to only one-third in MMP babies (p=0.01). EP cohort required PN for 82 days (median) in comparison to 17 days (median) in the MMP cohort (p=0.001). Ventilation requirement in the EP group versus the MMP group was 24 vs 9 days (median), respectively (p=0.0006).
MMP babies predominantly developed colonic disease, whereas EP babies predominantly developed small bowel disease. EP babies required a longer duration of PN and ventilation support. This study opens a new area of research to differentiate pathogenesis and maturation patterns of the small and large bowels in babies with NEC.
主要目的是检验我们的假设：“患有外科坏死性小肠结肠炎（NEC）的更成熟早产（MMP）婴儿是否主要发生结肠疾病，并且与极早产（EP）婴儿相比，其反应和表现是否不同？”次要结果是确定发生NEC的时间、从诊断到剖腹手术的时间、肠外营养（PN）的需求以及通气支持。
我们将MMP婴儿定义为妊娠≥30周，EP婴儿定义为妊娠≤29周。纳入标准为所有孕周<37周且患有NEC需要手术的婴儿（称为外科NEC组）。数据进行回顾性收集并使用QuickCalcs进行分析。
在2010年至2019年期间，共有41%（97/234）的婴儿接受了剖腹手术。其中，81%为EP婴儿，19%为MMP婴儿。9%的EP婴儿仅出现结肠受累，而MMP婴儿中这一比例为56%（p = 0.0001）。三分之二的EP婴儿仅出现小肠受累；相比之下，MMP婴儿中这一比例仅为三分之一（p = 0.01）。EP队列中位需要PN 82天，而MMP队列中位需要17天（p = 0.001）。EP组与MMP组的通气需求分别为24天和9天（中位数）（p = 0.0006）。
MMP婴儿主要发生结肠疾病，而EP婴儿主要发生小肠疾病。EP婴儿需要更长时间的PN和通气支持。本研究开辟了一个新的研究领域，以区分患有NEC的婴儿小肠和大肠的发病机制和成熟模式。
