A multicenter study on the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis
10.3760/cma.j.issn.2095-428X.2019.01.006
- VernacularTitle:新生儿坏死性小肠结肠炎临床特点及预后不良危险因素多中心研究
- Author:
Yueju CAI
1
;
Liuhong QU
;
Wei LI
;
Xue FENG
;
Liya MA
;
Bingyan YANG
;
Ping WANG
;
Juan TANG
;
Weiming YUAN
;
Yanbin LI
;
Xiaowen CHEN
;
Zhe ZHANG
;
Ning ZHAO
;
Xiaohong HUANG
;
Li TAO
;
Mou WEI
;
Heng SU
;
Weichi DENG
;
Kangcheng HE
;
Yitong WANG
;
Jinxing FENG
;
Di GAO
;
Yan HUANG
;
Wei ZHOU
Author Information
1. 广州市妇女儿童医疗中心新生儿科 510120
- Keywords:
Necrotizing enterocolitis;
Infant,newborn;
Clinical features;
Prognosis;
Risk factor
- From:
Chinese Journal of Applied Clinical Pediatrics
2019;34(1):24-29
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.
