Predictive Factors For Surgical Treatment In Preterm Neonates With Necrotizing Enterocolitis

Objective:To analyze the perinatal factors,clinical characteristics,auxiliary examination,treatment and other factors of conservative treatment and surgical treatment of necrotizing enterocolitis（NEC）in premature infants,the independent risk factors of surgical treatment were analyzed,and the surgical treatment prediction score table was drawn.It is helpful for the early identification and management of children with NEC who need surgery.Methods:The clinical data of premature infants diagnosed with NEC（≥ ⅡA stage）in the Neonatology Department of the First Hospital of Jilin University from January 1,2015 to October 30,2021 were retrospectively analyzed and divided into two groups according to the treatment plan: conservative treatment group（184 cases）,surgical treatment group（80 cases）.The clinical data of the two groups of children were analyzed,and IBM SPSS 25.0 statistical software was used to conduct univariate and multivariate Logistic regression analysis on the related factors of the conservative treatment group and the surgical treatment group,and to identify the independent risk factors of NEC surgical treatment for premature infants,and to identify the independent risk factors for NEC in premature infants.A scoring system was created using independent risk factors,a surgical treatment prediction score was drawn,and the prediction performance was evaluated by receiver operator characteristic（ROC）curve analysis.Result:（1）Univariate analysis results: Apgar 1-min,Apgar 5-min,mechanical ventilation,pulmonary surfactant（PS）,caffeine,peripherally inserted central catheter（PICC）,grade Ⅱ and above intracranial hemorrhage,anemia,Blood transfusion,onset time of NEC,days of feeding,food intake at onset,abdominal distension,peritoneal irritation,increased heart rate,metabolic acidosis,intestinal wall gas,portal gas,and intestinal dilatation were statistically significant（P<0.05）.（2）Multivariate Logistic regression analysis results: The statistical results were:abdominal color Doppler ultrasound: bowel dilatation（OR（odds ratio）=9.235,95%CI（confidence interval）: 4.123-20.687）,portal gas（OR=3.996,95%CI: 1.779-8.977）,intestinal gas（OR=3.95,95%CI: 1.748-8.936）,anemia（OR=3.228,95%CI:1.525-6.832）,metabolic acidosis（OR=3.43）,95%CI: 1.328-8.859),mechanical ventilation（OR=3.156,95%CI: 1.438-6.929）,peritoneal irritation（OR=4.05,95%CI:1.755-9.344）were independent risk factors for NEC surgical treatment.（3）7 independent risk factors were used to create a surgical treatment prediction score table,with a score range of 0-8 points,and further ROC curve analysis was performed.The area under the ROC curve was 0.872（95%CI:0.825-0.919）,when the cutoff value was At 3.5 points,the corresponding Youden index was the largest（0.633）,with a sensitivity and specificity of 82.1% and 81.2%.Conclusion:（1）Abdominal color Doppler ultrasound: bowel dilatation,portal gas,intestinal wall gas,anemia,metabolic acidosis,mechanical ventilation,and peritoneal irritation are independent risk factors for NEC surgical treatment.（2）The prediction performance of the NEC surgical treatment prediction scale is good,and it has certain value for guiding clinical treatment.