患有自发性肠穿孔（SIP）和外科坏死性小肠结肠炎（NEC）的新生儿按疾病发作、性别和干预措施划分的结局
Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC.
作者信息
Garg Parvesh Mohan, Lett Katheryn, Ansari Md Abu Yusuf, Cunningham Helen, Ware Jennifer, Pittman Isabella, Riddick Robin, Sawaya David, Berch Berry, Morris Michael, Varshney Neha, Shenberger Jeffrey S, Taylor Charlotte, Reddy Kartik, Hillegass William
机构信息
Department of Pediatrics/Neonatology, Wake Forest University, Winston-Salem, NC, USA.
Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, MI, USA.
出版信息
Pediatr Res. 2024 Mar;95(4):1009-1021. doi: 10.1038/s41390-023-02749-1. Epub 2023 Jul 24.
BACKGROUND
Outcomes of infants following surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) categorized by the age of onset, interventions, and sex are not well defined.
METHODS
Retrospective comparison of infants categorized by age of onset (NEC at <10, 10-20, and >20 days) and SIP at <7 versus ≥7 days), sex, and intervention [Penrose Drain (PD) vs. laparotomy].
RESULTS
A total of 114 infants had NEC and 37 had SIP. On multinomial logistic regression, infants with NEC/SIP onset >20 days had significantly lower odds of small bowel involvement (aOR = 0.07, 95% CI: 0.01-0.33, p = 0.001), higher necrosis (aOR = 3.59, 95% CI: 1.34-9.65, p = 0.012) and higher CRP (p = 0.004) than onset <10 days. Initial laparotomy was associated with more bowel loss (24.1 cm [12.3; 40.6] vs.12.1 [8.00; 23.2]; p = 0.001), small and large intestine involvement (47.1% vs 17.2%; p = 0.01), and ileocecal valve resection (42% vs. 19.4%; p = 0.036) than initial PD therapy. Females underwent fewer small bowel resections (52.3% vs 73.6%; p = 0.025) but had higher surgical morbidity (53.7% vs. 24.7%.; p = 0.001) than males.
CONCLUSION
Clinical, radiological, and histopathological presentation and outcomes in preterm infants with surgical NEC/SIP are associated with age of disease onset, sex, and initial intervention.
IMPACT
Neonates with surgical NEC onset >20 days had more severe necrosis, inflammation, kidney injury, and bowel loss than those with <10 days. Initial laparotomy was associated with later age onset, more bowel loss, and ileocecal valve resection compared to initial PD treatment, but not with differences in mortality or length of stay. Female sex was associated with lower maturity, more placental malperfusion, less often small bowel involvement, lower pre-NEC hematocrit as well as higher surgical morbidity than males. Whether the management of surgical NEC and SIP should differ by the age of onset requires further investigation.
背景
按发病年龄、干预措施和性别分类的坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）手术治疗后的婴儿结局尚未明确界定。
方法
对按发病年龄（NEC发病年龄<10天、10 - 20天和>20天，SIP发病年龄<7天与≥7天）、性别和干预措施[橡皮引流条（PD）与剖腹手术]分类的婴儿进行回顾性比较。
结果
共有114例婴儿患有NEC，37例患有SIP。在多项逻辑回归分析中，NEC/SIP发病>20天的婴儿小肠受累几率显著较低（调整后比值比[aOR]=0.07，95%置信区间[CI]：0.01 - 0.33，p = 0.001）、坏死程度较高（aOR = 3.59，95% CI：1.34 - 9.65，p = 0.012）以及C反应蛋白水平较高（p = 0.004）；与发病<10天的婴儿相比，初始剖腹手术与更多的肠管丢失（24.1厘米[12.3；40.6]对12.1[8.00；23.2]；p = 0.001）、小肠和大肠受累（47.1%对17.2%；p = 0.01）以及回盲瓣切除（42%对19.4%；p = 0.036）相关；与初始PD治疗相比。女性接受小肠切除术的比例较低（52.3%对73.6%；p = 0.025），但手术并发症发生率高于男性（53.7%对24.7%；p = 0.001）
结论
接受手术治疗的NEC/SIP早产儿的临床、放射学和组织病理学表现及结局与疾病发病年龄、性别和初始干预措施有关。
影响
手术性NEC发病>20天的新生儿比发病<10天的新生儿有更严重的坏死、炎症、肾损伤和肠管丢失。与初始PD治疗相比，初始剖腹手术与发病较晚、更多的肠管丢失和回盲瓣切除相关，但与死亡率或住院时间差异无关。女性与成熟度较低、胎盘灌注不良更多、小肠受累较少、NEC发病前血细胞比容较低以及手术并发症发生率高于男性有关。手术性NEC和SIP的治疗是否应根据发病年龄而有所不同，需要进一步研究。
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