Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
Ann Surg. 2024 Sep 1;280(3):432-443. doi: 10.1097/SLA.0000000000006378. Epub 2024 Jun 7.
We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure.
Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited.
This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables.
Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2).
This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.
我们旨在确定患有坏死性小肠结肠炎（NEC）或自发性肠穿孔（SIP）的婴儿生长不良的发生率，以及初始剖腹手术与腹腔引流（PD）是否会影响生长不良的可能性。
患有手术性 NEC 和 SIP 的婴儿死亡率很高，大多数都有神经发育损伤和生长不良。关于这些婴儿生长结果的现有文献是有限的。
这是坏死性小肠结肠炎手术试验数据集的预先计划的二次研究。主要结果是 18 至 22 个月时生长不良（体重 Z 分数<-2.0）。我们使用逻辑回归，包括诊断和治疗，作为协变量。使用Fisher 确切或 Pearson χ2 检验进行分类变量分析，使用 Wilcoxon 秩和检验或单向 ANOVA 进行连续变量分析。
在 217 名幸存者中，有 207 名婴儿（95%）有主要结果数据。18 至 22 个月时生长不良的发生率为 NEC 婴儿中的 24/50（48%）与 SIP 中的 65/157（42%）（P=0.4）。NEC 婴儿的 18 至 22 个月时体重年龄 Z 分数平均值为-2.05±0.99，而 SIP 为-1.84±1.09（P=0.2），SIP 的预测体重年龄 Z 分数平均值（Beta-0.27；95%置信区间：-0.53，-0.01；P=0.041）。所有婴儿的体重年龄 Z 分数从出生到 18 至 22 个月的中位数下降均具有显著意义，但在 NEC 婴儿中下降最严重（>2）（P=0.2）。
这是首次前瞻性研究手术性 NEC 或 SIP 婴儿的生长结果，表明生长不良非常常见，尤其是在 NEC 婴儿中，并且在 18-22 个月时仍然存在。
