患有外科坏死性小肠结肠炎的早产儿胆汁淤积的临床关联
Clinical Correlates of Cholestasis in Preterm Infants with Surgical Necrotizing Enterocolitis.
作者信息
Garg Parvesh Mohan, Pittman Isabella, Yi Joe, Weis Victoria G, Rodriguez Ricardo Jorge, Ladd Mitchell R, Rauh Jessica L, McDonald Anna Greene, Welch Cherrie, Premkumar Muralidhar Hebbur, Garg Padma P, Maheshwari Akhil
机构信息
Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America.
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.
出版信息
Newborn (Clarksville). 2023 Jul-Sep;2(3):191-197. doi: 10.5005/jp-journals-11002-0069. Epub 2023 Sep 26.
BACKGROUND
We sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC).
METHODS
Retrospective comparison of clinical information in preterm infants who developed cholestasis vs those who did not.
RESULTS
Sixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs 58.6%; = 0.002), had higher mean C-reactive protein levels 2 weeks after NEC diagnosis ( = 0.009), had blood culture-positive sepsis [25 (40.3%) vs 4 (13.8%); = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs 97.56 ± 56.05 days; = 0.007), had higher weight-for-length z scores at 36 weeks' postmenstrual age [-1.0 (-1.73, -0.12) vs -1.32 (-1.76, -0.76); = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs 112.51 ± 85.22 days; = 0.024), had intestinal failure more often (61% vs 25.0%, = 0.003), had more surgical complications (50% vs 27.6%; = 0.044), and had >1 complication (21% vs 3.4%; = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; = 0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; = 0.03) were independently associated with direct bilirubin between 2 and 5 mg/dL (mild-moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL (severe cholestasis) at 2 months of age in these patients.
CONCLUSION
Cholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.
背景
我们试图研究患有外科坏死性小肠结肠炎（sNEC）的早产儿胆汁淤积的临床决定因素及预后情况。
方法
对发生胆汁淤积的早产儿与未发生胆汁淤积的早产儿的临床信息进行回顾性比较。
结果
62例（62/91，68.1%）患有坏死性小肠结肠炎的婴儿在疾病发作后的任何时间出现了胆汁淤积。在sNEC诊断后24小时接受血管活性药物支持的婴儿中，胆汁淤积更为常见（87.1%对58.6%；P = 0.002），在NEC诊断后2周平均C反应蛋白水平更高（P = 0.009），血培养阳性败血症（25例[40.3%]对4例[13.8%]；P = 0.011），接受肠外营养（PN）的持续时间更长（108.4±56.63天对97.56±56.05天；P = 0.007），在孕龄36周时身长体重Z评分更高[-1.0（-1.73，-0.12）对-1.32（-1.76，-0.76）；P = 0.025]，住院时间更长（153.7±77.57天对112.51±85.22天；P = 0.024），更常出现肠衰竭（61%对25.0%，P = 0.003），有更多手术并发症（50%对27.6%；P = 0.044），以及有>1种并发症（21%对3.4%；P = 0.031）。使用线性回归分析，术后开始喂养的天数[比值比（OR）15.4；置信区间（CI）3.71，27.13；P = 0.009]和术后肠梗阻持续时间（OR 11.9，CI 1.1，22.8；P = 0.03）与2个月龄时直接胆红素在2至5mg/dL（轻度至中度胆汁淤积）独立相关。在这些患者中，PN持续时间与2个月龄时直接胆红素>5mg/dL（重度胆汁淤积）独立相关。
结论
68%的外科坏死性小肠结肠炎婴儿出现了胆汁淤积。最可能的促成因素是肠衰竭以及随后对PN的长期依赖。我们的数据表明，识别和预防败血症和手术并发症等危险因素以及NEC手术后早期喂养可能会改善预后。
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