| Objective:Neonatal necrotizing enterocolitis (NEC) is a serious acquired gastrointestinal disease frequently happened to infants and also one of the main reasons for their enterobrosis. It is usually associated with premature infant, especially very low birth weight (VLBW). It was reported at home and abroad that the morbidity of very low birth weight NEC is 5%-10%, and mortality rate is 10%-30%. With the introduction and development of advanced reproductive technology, and increasingly improved diagnose and treatment capability for newborns, the number of immature infants, VLBWs and critical neonates multiplies, so is the risk of NEC. Due to the highly dangerous morbidity and high mortality rate with complications, prevention is more important than treatment for NEC. The pathogenesis of NEC is currently still not fully understood, but human milk (HM) feeding is commonly recognized both at home and abroad as a good way to reduce morbidity and mortality of NEC. Based on the case-control study and the match result of-known risk factors of gestational age and birth weight, this study attempts to analyze relative dangerous clinical factors of NEC to VLBW and the protection of different dose HM under the condition that two main variants-gestational age and birth weight-are controlled, so as to provide clinical reference and instruction for the prevention and reduction of NEC morbidity and mortality.Method:The study adopts the retrospective analysis method towards 129 VLBW cases with gestational age between 26-32 weeks admitted to NICU of Women’s Hospital School of Medicine Zhejiang University from January 1st,2013 to December 31st,2015. Among the cases,43 infants clearly diagnosed with NEC are regarded as case group, while 86 VLBW infants without NEC but selected based on 1:2 pattern ratio of gestational age and birth weight are regarded as control group. Retrospective analysis method is used to compare and analyze the related factors between two groups, including (1) factors during perinatal period:mother’s premature rupture of fetal membrane during gestation, gestational hypertension, gestational diabetes mellitus, amniotic fluid pollution or not, and way of delivery, (2)1 factor of asphyxia history, (3)1 general factors of VLBW: gender, (4)2 factors of VLBW complications:neonatal respiratory distress syndrome (NRDS), neonatal patent ductus arteriosus (PDA), (5)Factors related to enteral feeding: based on case group’s disease onset time, making statistical analysis between 2 groups on milk category, first HM feeding time, volume of intake and HM proportion before NEC (in first week, second week, first 2 weeks, first 3 weeks, and time before disease), and comparing the differences between the two groups, (6) the usage of HM fortifierResult:When age and birth weight-are controlled, factors during mother’s perinatal period, like way of delivery, gestational diabetes mellitus, premature rupture of fetal membrane, amniotic fluid pollution, asphyxia and gestational hypertension, have no statistical significance on VLBW’s NEC difference(P>0.05). Factors like VLBW complications like NRDS, PDA and thrombocytopenia have no statistical differences on NEC and thus also have no statistical significance (P>0.05). The difference between mixed feeding and pure formula feeding has no statistical significance, but the average HM intake in control group is higher than those in case group, in particular the number of over 50% HM feeding is higher in control group. The longer the HM feeding, the more significant the difference is. Compared with those over 50% HM intake, infants with less than 50% HM intake face higher risk of NEC. The OR in first week after birth is 2.39 (95%CI 0.89-6.38, P=0.078), and in the second week number is 2.72(95%CI 1.13-6.58, P=0.023). The cumulative OR number for first 2 weeks is 3.14(95%CI 1.19-8.29, P=0.017), and the first 3 weeks OR number is 3.48(95%CI 1.32-9.15,P=0.009). The total OR of the statistical time is OR 4.03(95%CI 1.54-10.58,P=0.003). These numbers clearly indicate the accumulative effect of HM feeding’s protection against VLBW’s NEC.The usage of HM fortifier has no statistical significance on VLBW’s NEC (P>0.05).Conclusion:Under the condition that two main high risk factor-gestational age and birth weight-are controlled, other potential factors, like way of delivery, gestational diabetes mellitus, premature rupture of fetal membrane, amniotic fluid pollution, asphyxia and gestational hypertension, NRDS, PDA and so on, have no significant influence on NEC morbidity of VLBW. Under the condition of mixed feeding, the use of the formula significantly weakens HM’s the protection against NEC, while over 50% HM intake in total feeding have obvious protection of VLBW against NEC. Increasing HM feeding proportion to over 50%, or especially only HM feeding, is the most effective method to reduce the NEC morbidity in VLBW. |
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