OBJECTIVES: To study the differences in clinical characteristics of term and preterm neonates with necrotizing enterocolitis (NEC) undergoing surgical treatment. METHODS: A retrospective analysis was conducted on the clinical data of 142 NEC neonates who underwent surgery at the Children's Hospital of Chongqing Medical University from June 2017 to August 2023. The neonates were categorized into a preterm group (gestational age <37 weeks; 95 cases) and a term group (gestational age 37-42 weeks; 47 cases) to compare clinical characteristics. RESULTS: The preterm group had a higher postnatal age at both diagnosis and surgery compared to the term group (P<0.05). The preterm group also had a higher incidence of preoperative bloody stools, lower preoperative platelet counts, and higher rates of preoperative respiratory distress, apnea, reduced/absent bowel sounds, and mechanical ventilation compared to the term group (P<0.05). Postoperatively, the preterm group had higher rates of purulent meningitis, sepsis, and coagulation dysfunction, lower postoperative platelet counts, and lower intraoperative minimum body temperature than the term group (P<0.05). CONCLUSIONS There are significant differences in the clinical characteristics of preterm and term neonates with NEC undergoing surgery, suggesting the need for tailored perioperative management strategies based on these characteristics.
Humans ; Enterocolitis, Necrotizing/surgery* ; Infant, Newborn ; Retrospective Studies ; Male ; Female ; Infant, Premature ; Gestational Age

OBJECTIVETo improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively.

METHODData of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011.

RESULTAnalysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01).

CONCLUSIONAbdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.

Abdomen ; diagnostic imaging ; surgery ; Birth Weight ; Enterocolitis, Necrotizing ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; pathology ; surgery ; Infant, Premature ; Intestinal Perforation ; diagnostic imaging ; surgery ; Logistic Models ; Male ; Pneumoperitoneum ; diagnosis ; diagnostic imaging ; Portal Vein ; diagnostic imaging ; pathology ; Predictive Value of Tests ; Prognosis ; Radiography, Abdominal ; Retrospective Studies ; Severity of Illness Index ; Ultrasonography, Doppler, Color

OBJECTIVETo explore the value of the score for neonatal acute physiology (score for neonatal acute physiology, SNAP) in predicting outcome and risk of surgery of necrotizing enterocolitis (NEC).

METHODA total of 62 NEC patients in neonatal intensive care unit (NICU) of Zhejiang University Children's Hospital were reviewed from October 2001 to October 2011. All the patients were classified into surgery group and non-surgery group according to whether the patient had the surgical intervention. Also the patients were divided into death group and alive group according to the outcome. Data on gestational age at birth, gender, birth weight, early clinical manifestations, treatment and prognosis of all patients were collected. SNAP-II and score for neonatal acute physiology and perinatal extension II (SNAPPE-II) were calculated on the day of diagnosis.

RESULTAbdominal distension, which was seen in 91.9% of the cases, was the commonest early clinical manifestation. The next was residual and bloody stool. SNAP-II and SNAPPE-II score in surgery group (26.5,26.5) were higher than that of the non-surgery group (13.0, 13.0,P = 0.002, 0.006). And the same scores in death group (29.0,32.0) were higher than those in the alive group (8.0, 8.0) (P = 0.000, 0.000). Measuring the scores as a predictor of surgery, the area under ROC curve for SNAP-II was 0.745, and was 0.714 for SNAPPE-II. The area under ROC curve for SNAP-II was 0.916, and was 0.929 for SNAPPE-II.The best positive point of SNAP-II and SNAPPE-II for predicting surgery was 22 and 28. The best positive point of SNAP-II and SNAPPE-II for predicting death was 18.5 and 22.

CONCLUSIONThe SNAP-II and SNAPPE-II score may be used to predict the prognosis and the risk of surgery in the NEC patients. The scores are also good predictors of mortality in the early period when NEC occurs.

Apgar Score ; Area Under Curve ; Birth Weight ; Enterocolitis, Necrotizing ; diagnosis ; mortality ; surgery ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; mortality ; surgery ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Male ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Analysis

OBJECTIVETo evaluate the high-risk factors, prognostic factors, and operation time for surgical intervention in the treatment of necrotizing enterocolitis (NEC) in neonates.

METHODSSixty-two NEC neonates who received treatment in the neonatal intensive care unit from October 2001 to October 2011 were enrolled. Patients were assigned to surgery (n=20) and non-surgery groups (n=42). The two groups were compared with respect to general data, complications, clinical symptoms, laboratory examination results, treatment and prognosis.

RESULTSCompared with non-surgery group, the surgery group had significantly higher rates of respiratory distress syndrome, gurgling sound disappearance, C-reactive protein increase, platelet count decrease, positive blood culture, pneumoperitoneum and fixed intestinal loop on X-ray, and mechanical ventilation (P<0.05). Cured patients in the surgery group had significantly lower rates of circulation failure and multiple bowel perforations than patients who died (P<0.05), as shown by the prognostic factor analysis. Of the 20 patients in the surgery group, 19 (95%) underwent operation within one week after diagnosis of NEC and 15 survived the operation.

CONCLUSIONSThere are multiple risk factors in surgical intervention for NEC. Bowel lesions and circulation failure are associated with postoperative prognosis. The operation is usually performed within one week after diagnosis of NEC.

Enterocolitis, Necrotizing ; surgery ; Female ; Humans ; Infant, Newborn ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Prognosis ; Retrospective Studies

PURPOSE: This study investigated the clinical course and prognostic factor of very low birth weight infants (VLBWI) with hemodynamically significant congenital heart defects (CHDs). METHODS: Medical records of 1,098 VLBWI with birth weight <1,500 g who had been admitted to the neonatal intensive care unit of Samsung Medical Center from October 1994 to December 2007 were reviewed retrospectively. The data for these patients with hemodynamically significant CHD (n=33) were compared with those without CHD (n=1,065). RESULTS: The incidence of CHD was 3.0% (33 patients) 7 patients (21%) had CHD combined with the congenital abnormalities or chromosomal disorders. The most common CHD was a ventricular septal defect. The incidence of intrauterine growth retardation was higher in patients with CHD than in patients without CHD (34% vs. 20%), but there were no significant differences in gestational age, birth weight, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, severe intraventricular hemorrhage (> or =Gr III), and periventricular leukomalacia. Cardiac surgery was performed on 13 patients (39%). Nine patients received staged operations, and 10 patients received early intervention. The overall mortality in patients who had CHD was higher than in the patients who did not have CHD (27% vs. 16%). In patients with CHD, congenital abnormalities or chromosomal disorders were more important factors for increased mortality (86% vs. 11%) than the degree of complexity of CHD (19% vs. 42%). CONCLUSION: The most important prognostic factors of VLBWI with CHD are the associated congenital abnormalities or chromosomal disorders.
Birth Weight ; Bronchopulmonary Dysplasia ; Chromosome Disorders ; Congenital Abnormalities ; Early Intervention (Education) ; Enterocolitis, Necrotizing ; Fetal Growth Retardation ; Gestational Age ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Medical Records ; Prognosis ; Retrospective Studies ; Thoracic Surgery