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分析患有坏死性小肠结肠炎的早产儿的术后结果和宫外生长迟缓：一项回顾性研究。

Analysis of Postoperative Outcomes and Extrauterine Growth Retardation in Preterm Infants with Necrotizing Enterocolitis: A Retrospective Study.

机构信息

Department of Neonatology, School of Medicine, Shanghai Jiao Tong University, Shanghai Children's Hospital, Shanghai, China.

出版信息

Am J Perinatol. 2024 May;41(S 01):e1190-e1196. doi: 10.1055/s-0042-1760445. Epub 2023 Jan 16.

DOI:10.1055/s-0042-1760445
PMID:36646098
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11139500/
Abstract

OBJECTIVE: High mortality and extrauterine growth retardation (EUGR) remain serious problems in preterm infants after necrotizing enterocolitis (NEC) surgery. This study investigated the risk factors for mortality and EUGR in preterm infants after NEC surgery. STUDY DESIGN: The risk factors were analyzed retrospectively by univariate analysis and multivariate logistic regression analysis in 52 preterm infants, who underwent NEC surgery and were hospitalized in neonatology department of Shanghai Children's Hospital between May 2014 and December 2021. Patients were divided into survival and death groups. Survivors were divided into two groups according to whether EUGR occurred when they achieved full enteral feeding after surgery. RESULTS: The mortality of preterm infants after NEC surgery was 26.9% (14/52). About 55.3% (21/38) of survivors developed postoperative EUGR. (1) Age at surgery, proportion of shock, and intestinal perforation differed significantly between the survival and death groups ( = 0.001, 0.005, and 0.02, respectively). Shock ( = 0.02, odds ratio [OR] = 8.86, 95% confidence interval [CI]: 1.43-55.10) and intestinal perforation ( = 0.03, OR = 6.12, 95% CI: 1.16-32.41) were significant risk factors for death. (2) Compared with the non-EUGR group, proportion of preoperative EUGR, postoperative 1-week calories, and parenteral nutrition time differed significantly in EUGR group ( = 0.001, 0.01, and 0.04, respectively). Preoperative EUGR ( = 0.02, OR = 18.63, 95%CI: 1.77-196.42) was a significant risk factor for postoperative EUGR. CONCLUSION: Shock and intestinal perforation are significant risk factors for death in preterm infants after NEC surgery. Survivors are prone to EUGR, and preoperative EUGR is a significant risk factor. In addition, adequate caloric intake and achievement of full enteral feeding as soon as possible may be beneficial to improve EUGR of preterm infants after NEC surgery. KEY POINTS: · Shock and intestinal perforation are risk factors for death in preterm infants after NEC surgery.. · Preoperative EUGR is a risk factor for postoperative EUGR in preterm infants after NEC surgery.. · Active correction of shock and avoiding intestinal perforation may help improve the outcomes..

摘要

目的：坏死性小肠结肠炎（NEC）手术后的早产儿仍然存在高死亡率和宫外生长迟缓（EUGR）的问题。本研究旨在探讨 NEC 手术后早产儿发生死亡和 EUGR 的危险因素。

研究设计：采用单因素和多因素 logistic 回归分析，对 2014 年 5 月至 2021 年 12 月期间在上海儿童医学中心新生儿科接受 NEC 手术的 52 例早产儿的危险因素进行回顾性分析。患者分为存活组和死亡组。根据术后达到全肠内喂养时是否发生 EUGR，将存活者分为两组。

结果：NEC 手术后早产儿的死亡率为 26.9%（14/52）。约 55.3%（21/38）的幸存者发生术后 EUGR。（1）存活组和死亡组在手术时的年龄、休克比例和肠穿孔方面存在显著差异（=0.001、0.005 和 0.02）。休克（=0.02，OR=8.86，95%CI：1.43-55.10）和肠穿孔（=0.03，OR=6.12，95%CI：1.16-32.41）是死亡的显著危险因素。（2）与非 EUGR 组相比，EUGR 组的术前 EUGR、术后 1 周的热量和肠外营养时间存在显著差异（=0.001、0.01 和 0.04）。术前 EUGR（=0.02，OR=18.63，95%CI：1.77-196.42）是术后 EUGR 的显著危险因素。

结论：休克和肠穿孔是 NEC 手术后早产儿死亡的显著危险因素。幸存者易发生 EUGR，且术前 EUGR 是发生 EUGR 的显著危险因素。此外，摄入足够的热量并尽快达到全肠内喂养可能有利于改善 NEC 手术后早产儿的 EUGR。

重点：· 休克和肠穿孔是 NEC 手术后早产儿死亡的危险因素。· 术前 EUGR 是 NEC 手术后早产儿发生术后 EUGR 的危险因素。· 积极纠正休克和避免肠穿孔有助于改善预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/c08724a7411b/10-1055-s-0042-1760445-i22aug1509-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/ba7cf821cc66/10-1055-s-0042-1760445-i22aug1509-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/9a54446c3609/10-1055-s-0042-1760445-i22aug1509-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/c08724a7411b/10-1055-s-0042-1760445-i22aug1509-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/ba7cf821cc66/10-1055-s-0042-1760445-i22aug1509-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/9a54446c3609/10-1055-s-0042-1760445-i22aug1509-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e414/11139500/c08724a7411b/10-1055-s-0042-1760445-i22aug1509-3.jpg

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引用本文的文献

[1]
Nutritional management after necrotizing enterocolitis and focal intestinal perforation in preterm infants.

Pediatr Res. 2024-7-11

本文引用的文献

[1]
Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes.

Nutrients. 2022-2-22

[2]
Outcomes and Prognostic Factors for Survival of Neonates With Necrotizing Enterocolitis.

Front Pediatr. 2021-10-20

[3]
Case Report: Is Pneumoperitoneum the Only Indication for Surgery in Necrotizing Enterocolitis?

Front Pediatr. 2021-8-6

[4]
Association between postnatal growth and neurodevelopmental impairment by sex at 2 years of corrected age in a multi-national cohort of very preterm children.

Clin Nutr. 2021-8

[5]
Necrotizing Enterocolitis.

Clin Perinatol. 2021-6

[6]
Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation.

J Pediatr Surg. 2021-2

[7]
Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection.

Nutrients. 2020-2-18

[8]
New Nutritional and Therapeutical Strategies of NEC.

Curr Pediatr Rev. 2019

[9]
Extrauterine Growth Restriction in Low Birth Weight Infants.

Neonatal Netw. 2019-1

[10]
Nutrition Management of Necrotizing Enterocolitis.

Nutr Clin Pract. 2018-6-25

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