Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK; Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson UCL Institute for Women's Health, London, UK.
Department of Neonatology, Evelina London Children's Hospital, London, UK.
J Pediatr Surg. 2024 Feb;59(2):211-215. doi: 10.1016/j.jpedsurg.2023.10.010. Epub 2023 Oct 18.
Neonatal enterostomy is a known risk for growth failure. We hypothesized that episodes of inflammation may drive a catabolic state, exploring this by assessing serum biochemistry alongside growth trajectory in enterostomy patients.
A retrospective analysis of infants with histologically confirmed NEC from 01/2012-07/2021 in a tertiary neonatal surgical centre was performed. Change in weight-for-age Z-score (ΔZ) between stoma formation and closure was calculated. Serum CRP (C-reactive protein), urea, and creatinine levels were recorded and duration of elevated levels calculated as Area Under Curve (AUC). We examined for trends of serum levels rising together using intersecting moving averages. Spearman's correlation analysis was performed, while multivariable linear regression examined factors associated with ΔZ.
79 neonates were included. At stoma formation, median Z-score was -1.42 [range -4.73, +1.3]. Sixty-two patients (78 %) had a fall in Z-score during their time with a stoma, 16 (20 %) had a ΔZ less than -2. Urea AUC was significantly univariably correlated with ΔZ and remained statistically significant in a multivariable model (Exp(B) x 100 = -0.57[-1, -0.09]; p = 0.022). The number of biomarker peaks correlated significantly with ΔZ for urea (r = -0.25; p = 0.025) and CRP (r = -0.35; p = 0.0017) but not Creatinine (r = -0.21; p = 0.066). Analysing the number of peaks of any combination of variables coinciding was consistently significantly correlated negatively with ΔZ (r = -0.29 to -0.27; p ≤ 0.016 for all).
Our data shows that infants who were more severely affected by growth failure had more frequent and severe uremia while they had a stoma (suggesting a catabolic state). Disturbances in urea were commonly associated with CRP, suggesting that inflammation is a significant factor in growth failure in these infants. These findings promote aggressive management of sepsis in these infants, as well as suggesting an earlier closure of stoma to minimise their "at-risk"' period.
新生儿肠造口术是生长失败的已知风险。我们假设炎症发作可能会导致分解代谢状态，并通过评估肠造口术患者的血清生化指标和生长轨迹来对此进行探索。
对 2012 年 1 月至 2021 年 7 月在一家三级新生儿外科中心接受组织学证实为 NEC 的婴儿进行回顾性分析。计算造口形成与关闭之间体重与年龄 Z 分数（ΔZ）的变化。记录血清 CRP（C 反应蛋白）、尿素和肌酐水平，并计算 AUC（曲线下面积）以计算升高水平的持续时间。我们使用相交移动平均值检查血清水平是否同时升高的趋势。进行 Spearman 相关分析，同时多元线性回归分析与ΔZ 相关的因素。
纳入 79 名新生儿。在造口形成时，中位数 Z 分数为-1.42[范围-4.73，+1.3]。62 名患者（78%）在肠造口期间体重下降，16 名患者（20%）ΔZ 小于-2。尿素 AUC 与ΔZ 显著相关，在多变量模型中仍具有统计学意义（Exp（B）x 100=-0.57[-1，-0.09]；p=0.022）。生物标志物峰值的数量与尿素（r=-0.25；p=0.025）和 CRP（r=-0.35；p=0.0017）的ΔZ 显著相关，但与肌酐（r=-0.21；p=0.066）无关。分析任何组合变量的峰值数量一致与ΔZ 呈负相关（r=-0.29 至-0.27；p≤0.016 ）。
我们的数据表明，在肠造口期间，生长失败程度更严重的婴儿出现更频繁和严重的尿毒症（提示分解代谢状态）。尿素紊乱常与 CRP 相关，提示炎症是这些婴儿生长失败的重要因素。这些发现促进了对这些婴儿脓毒症的积极治疗，并建议尽早关闭造口以尽量减少其“高危”期。
