Kabeer A, Gunnlaugsson S, Coren C
Department of Surgery, Nassau County Medical Center, East Meadow, New York 11554, USA.
Dis Colon Rectum. 1995 Aug;38(8):866-72. doi: 10.1007/BF02049844.
A retrospective, 12-year review of neonatal necrotizing enterocolitis was undertaken at a county hospital, with emphasis on presentation signs and symptoms.
Eight-two patients with presence of intramural air were included in the study. The following signs and symptoms were studied: evidence of respiratory distress, use of umbilical catheters, white blood cell count and temperature at presentation, time interval from birth to diagnosis and time interval from diagnosis to operative intervention, presence of intramural air, air in biliary tree or free air, changes in abdominal girth, and presence of occult or gross blood in stools. Comparison was done among infants who had surgical or medical treatment, premature and full-term infants, and infants who had neonatal necrotizing enterocolitis less than or more than 20 days after birth.
Eleven patients had a fatal outcome, with an overall survival of 87 percent. Sixty-four patients were treated medically and 18 had operative treatment. Mortality of the surgically treated group was 44 percent. Neonates who had surgical intervention had a left shift of the white blood cell count more commonly present, and all had documented abdominal distention. There were 62 premature and 20 full-term neonates in the group. Full-term neonates developed neonatal necrotizing enterocolitis earlier after birth (5.3 days compared with 15.3 days in the premature neonate group). Full-term neonates had a better prognosis in our series. Presentation of symptoms more than 20 days after birth did not change outcome.
Our results reflect the experience of a community-based hospital. Clinical acumen remains the cornerstone of diagnosis and management.
在一家县级医院对新生儿坏死性小肠结肠炎进行了为期12年的回顾性研究，重点关注临床表现和症状。
本研究纳入了82例存在肠壁积气的患者。对以下临床表现和症状进行了研究：呼吸窘迫迹象、脐静脉置管使用情况、就诊时的白细胞计数和体温、从出生到诊断的时间间隔以及从诊断到手术干预的时间间隔、肠壁积气情况、胆管积气或游离气体情况、腹围变化以及粪便中潜血或肉眼可见血的情况。对接受手术或非手术治疗的婴儿、早产儿和足月儿，以及出生后20天以内或超过20天患新生儿坏死性小肠结肠炎的婴儿进行了比较。
11例患者死亡，总生存率为87%。64例患者接受了非手术治疗，18例接受了手术治疗。手术治疗组的死亡率为44%。接受手术干预的新生儿更常见白细胞计数左移，且均有腹胀记录。该组中有62例早产儿和20例足月儿。足月儿出生后较早发生新生儿坏死性小肠结肠炎（5.3天，而早产儿组为15.3天）。在我们的系列研究中，足月儿预后较好。出生后20天以上出现症状并未改变预后。
我们的结果反映了一家社区医院的经验。临床敏锐度仍然是诊断和管理的基石。
