Doctoral Programme of Brawijaya University, Faculty of Medicine, Department of Medical Science, Malang, East Java, Indonesia.
University of Brawijaya, Dr. Saiful Anwar General Hospital-Faculty of Medicine, Department of Paediatrics, Malang, Indonesia.
Med J Malaysia. 2023 Jul;78(4):458-465.
Necrotising enterocolitis (NEC) is a serious health problem primarily affects preterm and very low birthweight (VLBW) infants. However, the pathomechanism of NEC remains elusive. This study aimed to analyse the risk factors for NEC among preterm neonates in East Java, Indonesia.
A single-centre, prospective, casecontrol study involving 32 subjects of preterm neonates was conducted at a tertiary care hospital in Malang, East Java, Indonesia between January to June 2022. A total of 15 preterm neonates with NEC and 17 preterm neonates without NEC were enrolled in this study. Data on demographic, clinical and laboratory findings were collected. Multiple logistic regression test was performed to analyse the risk factors for NEC development. Further profiling within 15 subjects with NEC, i.e., NEC grade ≥ II, were conducted to collect systemic, abdominal, laboratory, abdominal x-ray (AXR) and blood culture findings.
The risk factors related to NEC development in preterm infants were multi-morbidity (adjusted OR = 11.96; 95% CI 1.85 168.38; p = 0.046), antibiotic exposure (OR = 15.95; 95% CI 1.54 165.08; p = 0.020) and requiring advanced neonatal resuscitation at birth (OR = 10.04; 95% CI 1.09 92.11; p = 0.041). Further profiling within NEC cohorts highlighted respiratory distress (86.7%), (oro)gastric retention (80.0%), thrombocytopenia (53.3%), gastrointestinal dilatation in AXR (53.3%), and positive blood culture Klebsiella pneumoniae (40.0%) were most common findings.
Preterm neonates with multimorbidity, prolonged antibiotic exposure, and requiring advanced resuscitation at birth were more likely to develop NEC. Early detection of the risk factors and determinant factors for survival may help to improve the clinical outcome.
坏死性小肠结肠炎（NEC）是一种主要影响早产儿和极低出生体重儿（VLBW）的严重健康问题。然而，NEC 的发病机制仍不清楚。本研究旨在分析印度尼西亚东爪哇省早产儿患 NEC 的危险因素。
这是一项在印度尼西亚东爪哇省玛琅的一家三级保健医院进行的单中心、前瞻性、病例对照研究。该研究纳入了 2022 年 1 月至 6 月期间的 32 名早产儿，共纳入了 15 名患有 NEC 的早产儿和 17 名没有 NEC 的早产儿。收集了人口统计学、临床和实验室数据。采用多因素逻辑回归分析 NEC 发生的危险因素。对 15 名 NEC 患儿进行了进一步的分析，即 NEC 分级≥Ⅱ级，收集全身、腹部、实验室、腹部 X 线（AXR）和血培养结果。
早产儿患 NEC 的危险因素是合并多种疾病（调整后的 OR=11.96；95%CI 1.85-168.38；p=0.046）、暴露于抗生素（OR=15.95；95%CI 1.54-165.08；p=0.020）和出生时需要高级新生儿复苏（OR=10.04；95%CI 1.09-92.11；p=0.041）。在 NEC 队列中进一步分析显示，最常见的表现是呼吸窘迫（86.7%）、（口）胃潴留（80.0%）、血小板减少症（53.3%）、AXR 上胃肠道扩张（53.3%）和血培养阳性肺炎克雷伯菌（40.0%）。
患有多种合并症、长期使用抗生素和出生时需要高级复苏的早产儿更有可能患 NEC。早期发现危险因素和生存的决定因素可能有助于改善临床结局。
