Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
J Neonatal Perinatal Med. 2023;16(1):93-103. doi: 10.3233/NPM-221105.
To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC.
A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions.
In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039).
Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.
为了确定胎盘病理损伤与接受手术的早产儿患坏死性小肠结肠炎（NEC）后的结局、存活率和脑白质损伤（WMI）之间的关联。
对 2013 年 1 月至 2020 年 6 月期间 107 例（Bell 分期>IIa）患有 NEC 的新生儿进行了回顾性图表审查。比较了有和无胎盘病理损伤的婴儿之间的人口统计学、临床和结局数据。
在该队列中，59/107（55%）例婴儿患有医学 NEC，48（45%）例患有手术 NEC。婴儿的平均胎龄为 28.1±3.7 周，出生体重为 1103±647g。最常见的胎盘病理损伤为母体血管功能不全（82/107，76.6%）和急性组织学绒毛膜羊膜炎（42，39.3%）。与医学 NEC 相比，手术 NEC 中更常见急性组织学绒毛膜羊膜炎伴有胎儿炎症反应（35.4% vs. 15.3%；p=0.02）。在接受脑部 MRI 扫描有 WMI 的 NEC 婴儿中，急性组织学绒毛膜羊膜炎的发生率显著更高（52% vs. 27.8%；P=0.04）。在有和没有急性组织学绒毛膜羊膜炎伴有胎儿炎症反应的新生儿中，死亡率、住院时间和术后结局无显著差异。在未调整的逻辑回归中，无胎儿炎症反应的急性组织学绒毛膜羊膜炎也与 WMI 的发生几率更高相关（OR 2.81；95% CI 1.05-7.54；p=0.039）。
无胎儿炎症反应的急性组织学绒毛膜羊膜炎与 NEC 婴儿的 WMI 发生几率增加相关，对死亡率和其他术后结局无显著影响。
