Department of Pediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
BMC Pediatr. 2023 Jul 13;23(1):356. doi: 10.1186/s12887-023-04173-0.
Neonatal necrotizing enterocolitis (NEC) is a common critical illness of the gastrointestinal system in neonatal intensive care units with complex causes. We want to explore effects of serum-conjugated bilirubin on the occurrence of NEC in preterm infants.
A retrospective study of clinical case data of premature infants from 2017 to 2020 in the Department of pediatrics of the First Affiliated Hospital of Nanjing Medical University was conducted. Among these, 41 were diagnosed with NEC. After screening, 2 cases were excluded because of incomplete data. Propensity-matching score (PSM) was performed according to the ratio of 1:2(2 preterm infants in the NEC group were not matched), and finally, 37 cases were in the NEC group (average time to diagnosis was 18.9 days), and 74 cases in the non-NEC group. We compared the difference between the NEC and non-NEC groups in early serum-conjugated bilirubin and total bilirubin levels (time points: the first day of birth, 1 week after birth, 2 weeks after birth).
(1) The changing trend of conjugated bilirubin was different between the two groups(F = 4.085, P = 0.019). The NEC group's serum-conjugated bilirubin levels gradually increased ([Formula: see text] ± s:12.64±2.68; 17.11±4.48; 19.25±11.63), while the non-NEC group did not show a continuous upward trend ([Formula: see text] ± s:13.39±2.87; 15.63±3.75; 15.47±4.12). (2) Multiple analyses showed that patent ductus arteriosus(PDA) (odds ratio[OR] = 5.958, 95%confidence interval[CI] = 2.102 ~ 16.882) and increased conjugated bilirubin in the 2nd week (OR = 1.105, 95%CI = 1.013 ~ 1.206) after birth were independent risk factors for NEC.
The body had already experienced an elevation of conjugated bilirubin before the occurrence of NEC. The change of early conjugated bilirubin may be an important factor in the occurrence of NEC.
新生儿坏死性小肠结肠炎（NEC）是新生儿重症监护病房中一种常见的胃肠道系统危急重症，病因复杂。我们旨在探讨血清结合胆红素对早产儿 NEC 发病的影响。
回顾性分析 2017 年至 2020 年南京医科大学第一附属医院儿科收治的早产儿临床病例资料，共纳入 41 例 NEC 患儿，经筛选剔除因资料不全的 2 例患儿，采用 1:2 （NEC 组 2 例患儿不匹配）的比例进行倾向性评分匹配（PSM），最终 NEC 组纳入 37 例（发病平均时间 18.9 天），非 NEC 组纳入 74 例。比较 NEC 组与非 NEC 组患儿出生第 1 天、生后 1 周、生后 2 周时早期血清结合胆红素和总胆红素水平的差异。
（1）两组患儿的结合胆红素变化趋势不同（F=4.085，P=0.019）。NEC 组患儿血清结合胆红素水平逐渐升高[（12.64±2.68）、（17.11±4.48）、（19.25±11.63）]，而非 NEC 组患儿未呈现持续升高趋势[（13.39±2.87）、（15.63±3.75）、（15.47±4.12）]。（2）多因素分析显示，动脉导管未闭（PDA）（比值比[OR]=5.958，95%置信区间[CI]：2.10216.882）和生后第 2 周结合胆红素升高（OR=1.105，95%CI：1.0131.206）是 NEC 的独立危险因素。
NEC 发病前患儿体内已出现结合胆红素升高，早期结合胆红素变化可能是 NEC 发病的重要因素。
