Clinical characteristics analysis of intestinal stenosis after necrotizing enterocolitis in premature infants
10.3760/cma.j.issn.1673-4408.2025.08.008
- VernacularTitle:早产儿坏死性小肠结肠炎后肠狭窄的临床特点分析
- Author:
Feng WU
1
;
Pengjun SU
Author Information
1. 中国医科大学附属盛京医院新生儿外科，沈阳 110004
- Keywords:
Premature infants;
Necrotizing enterocolitis;
Intestinal stenosis;
Risk factors
- From:
International Journal of Pediatrics
2025;52(8):541-546
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics of intestinal stenosis in premature infants with necrotizing enterocolitis（NEC）.Methods:A retrospective analysis was conducted on the clinical data of premature infants with intestinal stenosis after NEC admitted to Shengjing Hospital of China Medical University from 1st January 2012 to 31st December 2021.Patients were divided into the surgery group and the medication group based on whether they underwent surgery during the acute phase.The general clinical characteristics，location of intestinal stenosis，and severity of intestinal lesions were analyzed.Clinical data of premature infants with NEC who recovered without intestinal stenosis after conservative medical treatment during the same period were collected and compared with those of the premature infants with intestinal stenosis in the medication group to further understand the clinical characteristics and risk factors of intestinal stenosis after NEC in the medication group.Results:Among 107 children with NEC-induced intestinal stenosis（18.8%），18（18/167，10.8%）were in the surgery group and 89（89/403，22.1%）were in the medication group.There were no significant differences in birth weight［（1 724.1±827.8）g vs.（1 761.5±995.8）g］and age at onset［（14.5±6.7）d vs.（13.9±9.4）d］during the acute phase between the medication and surgery groups（ P>0.05）.The surgery group had significantly higher rates of mechanical ventilation after onset（17/18 vs.28/89）and a higher incidence of shock（18/18 vs.42/89），both with statistically significant differences（ P<0.01）.However，in Bell stages Ⅱ and Ⅲ，the incidences of intestinal stenosis in the surgery group（8/76 and 10/91）were lower than those in the medication group（49/72 and 10/11），and the extent of intestinal stenosis involvement was also significantly lower（19/167 vs.155/403），with statistical significance（ P<0.01）.In the medication group with/without intestinal stenosis，there were statistically significant differences in localized abdominal wall redness（46/89 vs.12/314），CRP levels［（62.834±58.463）mg/L vs.（41.444±39.116）mg/L］，pH value（7.221±0.251 vs.7.322±0.347），ultrasound-detected intestinal wall masses（36/89 vs.18/314），shock（42/89 vs.65/314），and mechanical ventilation ≥7 days（28/89 vs.12/314），all P<0.01.Logistic multivariate stepwise regression analysis revealed that acute abdominal wall redness，ultrasound-detected abdominal masses，CRP>30 mg/L（≥7 days），and mechanical ventilation ≥7 days were independent risk factors for the development of intestinal stenosis after NEC（ P<0.05）. Conclusion:The degree of intestinal inflammation during the acute phase of NEC affects the occurrence and extent of late stage intestinal stenosis，and surgical intervention during the acute phase alters the natural evolution process of NEC inflamed intestines.For newborns with high-risk factors for NEC induced intestinal stenosis，close observation，early prevention and intervention are necessary to improve the prognosis of the affected infants.
