Chen Minming, Feng Wei, Hou Jinping, Die Xiaohong, Guo Zhenhua, Wang Yi
Department of General & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Front Pediatr. 2025 Jan 6;12:1452207. doi: 10.3389/fped.2024.1452207. eCollection 2024.
To investigate the clinical features of necrotizing enterocolitis-associated intestinal perforation (NEC-IP) in neonates with different gestational ages (GAs). Furthermore, we also want to identify the risk factors of poor prognosis for these patients.
The retrospective study of patients with NEC-IP was conducted with basic information, comorbidity, intraoperative findings, related treatment, and prognosis. According to the GA, patients were divided into three groups: early (GA: 28-<32 weeks, Group 1), mid-term (GA: 32-<34 weeks, Group 2), and late (GA: 34-<37 weeks, Group 3). The clinical features of the three groups were analyzed, and risk factors for poor prognosis were identified.
Of the 113 cases, the number of cases in Groups 1 to 3 was 36 (31.9%), 44 (38.9%), and 33 (29.2%), respectively; and the overall proportion of poor prognosis was 19.4% (22/113). For basic information, the birth weight of Group 1 was lower than that of Group 2 and Group 3, while the postnatal day at the time of surgery of NEC and the onset age were higher than that of Group 2 (onset age: G1 12.0[7.00;20.5], G2 9.00[4.00;13.0]; postnatal day at the time of surgery: G1 22.0[13.8;27.2], G2 13.0[8.00;21.0]) ( < 0.016). For comorbidity, the incidence of sepsis, coagulopathy, type of (congenital heart disease) CHD, and hypoproteinemia in Group 1 was higher than that in Group 2 (all < 0.016), and the incidence of respiratory failure, hypoproteinemia in Group 1 was higher than that in Group 3 (all < 0.016). For related treatment, the usage rate of vasoactive substances and mechanical ventilation in Group 1 was higher than that of Group 2 and Group 3 (all < 0.016). By Lasso and Logistic regression analysis, we found that GA (OR: 0.274, 95%CI: 0.078-0.796), sepsis (OR: 7.955, 95%CI: 1.424-65.21), coagulopathy (OR: 19.51, 95%CI: 3.393-179.1), CHD (OR: 6.99, 95%CI: 1.418-54.83) and diseased bowel segment (OR: 2.804, 95%CI: 1.301-7.316) were the independent factors for poor prognosis (all < 0.05).
The clinical features of NEC-IP patients differ based on GA, particularly in terms of CHD type, postnatal day at the time of surgery, utilization of vasoactive substances, and prognosis. Furthermore, GA, sepsis, coagulopathy, CHD, and diseased bowel segment are independent factors for poor prognosis of patients with NEC-IP.
探讨不同胎龄（GA）新生儿坏死性小肠结肠炎相关肠穿孔（NEC-IP）的临床特征。此外，我们还想确定这些患者预后不良的危险因素。
对NEC-IP患者进行回顾性研究，记录基本信息、合并症、术中发现、相关治疗及预后情况。根据GA将患者分为三组：早期（GA：28-<32周，第1组）、中期（GA：32-<34周，第2组）和晚期（GA：34-<37周，第3组）。分析三组的临床特征，并确定预后不良的危险因素。
113例患者中，第1至3组的病例数分别为36例（31.9%）、44例（38.9%）和33例（29.2%）；预后不良的总体比例为19.4%（22/113）。基本信息方面，第1组的出生体重低于第2组和第3组，而NEC手术时的出生后天数和发病年龄高于第2组（发病年龄：第1组12.0[7.00；20.5]，第2组9.00[4.00；13.0]；手术时出生后天数：第1组22.0[13.8；27.2]，第2组13.0[8.00；21.0]）（<0.016）。合并症方面，第1组败血症、凝血功能障碍、先天性心脏病（CHD）类型和低蛋白血症的发生率高于第2组（均<0.016），第1组呼吸衰竭、低蛋白血症的发生率高于第3组（均<0.016）。相关治疗方面，第1组血管活性物质和机械通气的使用率高于第2组和第3组（均<0.016）。通过Lasso和Logistic回归分析，我们发现GA（OR：0.274，95%CI：0.078-0.796）、败血症（OR：7.955，95%CI：1.424-65.21）、凝血功能障碍（OR：19.51，95%CI：3.393-179.1）、CHD（OR：6.99，95%CI：1.418-54.83）和病变肠段（OR：2.804，95%CI：1.301-7.316）是预后不良的独立因素（均<0.05）。
NEC-IP患者的临床特征因GA而异，特别是在CHD类型、手术时出生后天数、血管活性物质的使用和预后方面。此外，GA、败血症、凝血功能障碍、CHD和病变肠段是NEC-IP患者预后不良的独立因素。
