Ohtani Tomohiro, Ichinose Mari, Ariyoshi Yu, Irie Miho, Toshimitsu Masatake, Sayama Seisuke, Seyama Takahiro, Muto Hiroshi, Shitara Yoshihiko, Ito Atsushi, Yoshida Mariko, Kakiuchi Satsuki, Ishiguro Akio, Kumasawa Keiichi, Iriyama Takayuki, Fujishiro Jun, Takahashi Naoto, Hirota Yasushi, Osuga Yutaka
Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Pediatrics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Obstet Gynaecol Res. 2025 Sep;51(9):e70075. doi: 10.1111/jog.70075.
Intestinal disorders (ID) impose a significant burden on preterm infants. Although previous studies have examined individual risk factors for types of ID such as necrotizing enterocolitis (NEC), meconium-related ileus (MRI), and focal intestinal perforation (FIP), the overarching etiology of ID as a whole remains underexplored. Therefore, this study aimed to identify obstetric risk factors for ID.
We retrospectively investigated singletons without congenital anomalies born between 22 weeks 0 days and 28 weeks 6 days of gestation between January 2013 and December 2022. We compared the frequencies of obstetric factors between patients with ID (ID group) and those without (non-ID group). The obstetric risk factors were maternal background, complications, fetal growth restriction (FGR), chorioamnionitis, Apgar score, and umbilical artery blood gas.
A total of 119 preterm infants were investigated. Of these, 22 (18.5%) had ID, including 14 MRI, 4 FIP, and 5 NEC cases. A total of 33 infants (27.7%) had FGR, which was more common in the ID group (10/22, 45.5% vs. 23/97, 23.7%, p = 0.047). Among patients with FGR, the median time from the onset of Doppler abnormalities in the umbilical artery, middle cerebral artery, or ductus venosus to delivery was significantly longer in patients with ID than in those without (180 h vs. 24 h, p = 0.049).
FGR was potentially associated with ID in preterm infants. To our knowledge, this is the first study to highlight the impact of prolonged Doppler abnormalities on ID development. These findings suggest that a chronically stressful intrauterine environment may increase postnatal intestinal vulnerability.
肠道疾病（ID）给早产儿带来了沉重负担。尽管先前的研究已经考察了诸如坏死性小肠结肠炎（NEC）、胎粪性肠梗阻（MRI）和局灶性肠穿孔（FIP）等ID类型的个体风险因素，但ID作为一个整体的总体病因仍未得到充分探索。因此，本研究旨在确定ID的产科风险因素。
我们回顾性调查了2013年1月至2022年12月期间妊娠22周0天至28周6天出生的无先天性异常的单胎婴儿。我们比较了ID患者（ID组）和无ID患者（非ID组）的产科因素频率。产科风险因素包括母亲背景、并发症、胎儿生长受限（FGR）、绒毛膜羊膜炎、阿氏评分和脐动脉血气。
共调查了119名早产儿。其中，22名（18.5%）患有ID，包括14例MRI、4例FIP和5例NEC病例。共有33名婴儿（27.7%）患有FGR，在ID组中更常见（10/22，45.5%对23/97，23.7%，p = 0.047）。在患有FGR的患者中，ID患者从脐动脉、大脑中动脉或静脉导管出现多普勒异常到分娩的中位时间显著长于无ID患者（180小时对24小时，p = 0.049）。
FGR可能与早产儿的ID相关。据我们所知，这是第一项强调延长的多普勒异常对ID发展影响的研究。这些发现表明，长期处于应激状态的子宫内环境可能会增加出生后肠道的易损性。
