Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan.
Pediatr Surg Int. 2023 Feb 4;39(1):102. doi: 10.1007/s00383-023-05390-5.
Our previous clinical pilot study reported that miconazole (MCZ) prevented morbidity from surgical necrotizing enterocolitis (NEC). The present study re-investigated this effect in a long-term cohort over 20 years.
We conducted a retrospective cohort study from April 1998 to March 2020. A total of 1169 extremely low-birth-weight infants (ELBWIs) admitted to our neonatal intensive care unit, including 45 with NEC (3.8%), underwent surgery. Since 2002, protocol MCZ administration for 3 weeks has been applied for neonates born before 26 weeks' gestation or weighing under 1000 g. We compared the background characteristics and clinical outcomes between patients with and without MCZ administration.
The morbidity rate decreased after applying the MCZ protocol, but no improvement in mortality was seen. A propensity score-matched analysis indicated that treated patients by MCZ showed a delay in developing surgical NEC by 12 days. The MCZ protocol also helped increase body weight at surgery. Prophylactic MCZ administration did not improve the neurological development of the language-social and postural-motor domains in the surgical NEC patients. But cognitive-adaptive domain caught up by a chronological age of 3 years old.
Revising the protocol to extend the dosing period may improve the outcomes of surgical NEC after the onset.
我们之前的临床试点研究报告称咪康唑（MCZ）可预防手术性坏死性小肠结肠炎（NEC）的发病。本研究在 20 多年的长期队列中重新调查了这种效果。
我们进行了一项回顾性队列研究，时间为 1998 年 4 月至 2020 年 3 月。共有 1169 名极低出生体重儿（ELBWIs）入住我们的新生儿重症监护病房，其中 45 名患有 NEC（3.8%）并接受了手术。自 2002 年以来，对于 26 周前出生或体重低于 1000 克的新生儿，应用方案 MCZ 治疗 3 周。我们比较了接受和未接受 MCZ 治疗的患者的背景特征和临床结局。
应用 MCZ 方案后发病率降低，但死亡率未见改善。倾向评分匹配分析表明，接受 MCZ 治疗的患者发生手术性 NEC 的时间延迟了 12 天。MCZ 方案还有助于增加手术时的体重。预防性 MCZ 给药并未改善手术性 NEC 患者的语言-社会和姿势-运动领域的神经发育。但认知-适应领域在 3 岁时赶上了正常年龄。
修订方案以延长用药时间可能会改善发病后的手术性 NEC 结局。
