| Background:Although medical technology for neonates continues improving, neonatal necrotizing enterocolitis (NEC) remains one of the severe diseases in the neonatal period.Because of its high incidence in premature infants, most of the previous studies focused on premature infants’ NEC. But in clinical practice, the term infants’NEC is not uncommon.There have been some small sample studies reported. At present, there is still a lack of large sample studies on the clinical characteristics of term infants’ NEC, and studies of the differences between term and premature infants’.To deepen the understanding of the term infants’ NEC is the urgent task of clinical researchers.Most of the researches on the risk factors of NEC are about a single factor or small sample studies. Moreover, many findings are inconsistent and lack effective predictions. More large sample studies are needed to predict the risk of NEC.According to Bell’s staging criterion, NEC cases were classified into stage I suspected cases, stage II confirmed cases and stage III severe cases.Clinically serious cases are not uncommon.Treatment includes supportive treatment, drug therapy and surgical treatment.In some cases, surgical treatment eventually had to be carried out after a period of supportive and drug treatment.At present, there is no large sample study on the prediction of the progress of NEC cases,such as the suspected cases progressed to the confirmed cases, or common cases progressed to surgical intervention case. Therefore, preventing the occurrence of NEC, and blocking the progress of suspected cases to confirmed cases or the progress of the common case to severe cases, is the urgent problem to be solved.Objective:To strengthen the understanding of the composition and the general characteristics of NEC population, and study the clinical characteristics of NEC in term and premature infants. To establish the diagnosis risk prediction model and the progress risk prediction model of NEC, in order to prevent and treat different populations’ NEC effectively.Subject and Methed:The clinical datas of neonates diagnosed with NEC Bell stage Ⅱ～Ⅲ were collected in six different hospitals in Guangdong province from January 2005 to December 2014. The clinical datas of neonates diagnosed with NEC Bell stagel were collected in our medical center from July 2013 to December 2016.The general datas, clinical symptoms, laboratory tests, X-ray reports, treatment methods, hospitalization and other relevant datas were included. R*C contingency table were used to study the related characteristics changes of Bell stage Ⅱ～Ⅲ NEC cases in ten years. Case－control studies were used to analyze the clinical characteristics of stage Ⅱ～Ⅲ NEC cases in term and premature infants. Single factor and multivariate logistic regression analysis in SPSS 20 version were used to establish the risk prediction model for diagnosis of stage Ⅱ～Ⅲ NEC, as well establish the risk prediction model for progress of stage Γ suspected cases progressed to the stage Ⅱ confirmed cases and the medical treatment cases progressed to the surgical cases. Hosmer-Lemeshow(H-L)χ2 test and the Receiver Operating Characteristic(ROC) curve were used to investigate goodness of fit and forecast accuracy respectively.Results:(1) A total of 835 cases of stage Ⅱ～Ⅲ were collected from the six cooperative hospitals, including 521 cases of males and 314 cases of females, 269 cases of term infants and 566 cases of premature infants, 641 cases of medical treatment, 158 cases of surgical treatment and 36 cases of abondoning treatment. 492 stage Ⅰ cases were collected from the our medical center, including 269 cases of males and 223 cases of females, 198 cases progressed to stage Ⅱ and 294 cases were excluded from NEC diagnosis.(2) For the stage Ⅱ～Ⅲ NEC cases from Guangdong in the decade, male is more than female(1.7:1), and the number of cases with birth weight of 1500～2499g was higher from January 2005 to December 2008. Since 2009 there were more cases of birth weight of 1000～1499g, and there was significant difference between the two groups (x2=53.288,P=0.000). There was statistical significance between the groups in different periods of operative age, staging and surgical operative methord;surgical age decreased gradually (χ2=2.158, P =0.039). The proportion of stage III severe cases was significantly lower than before (χ2=51.034, P =0.000). In 2008, the proportion of intestinal anastomosis was gradually increased (χ2=15.332, P=0.004).(3)The diagnosis and operation time of the stage Ⅱ～Ⅲ NEC cases in term infants were earlier than that of premature infants (χ2=9.861,P=0.000; x2=8.574,P=0.000),and the proportion of severe cases requiring surgical treatment was higher than that in premature infants (χ2=7.106,P =0.008). The common clinical symptoms of term infants cases were vomiting and bloody stool (χ2=-9.861,P=0.000 ; χ2=8.574,P=0.000).Premature infants are more likely to suffer from apnea and abdominal flushing (χ2=81,022,P=0.000 ; χ2=37.105,P=0.000). The incidence of intestinal stenosis was higher in preterm infants (χ2=17.201, P =0.000). Premature infants are more likely to have blood glucose>12mmol/L and associated with severe blood coagulation dysfunction APTT>100s (x2=10.460,P=0.005 ; χ2=13.010,P=0.001).Term infants are more likely to develop extensive focal necrosis (χ2=9.530,P=0.002).The incidence of total intestinal necrosis in premature infants is high (χ2=4.226, P=0.040).(4)Revealed the high-risk factors of NEC in term infants are feeding intolerance (OR 6.67 ;95%CI 3.58--13.18), artificial feeding (OR 7.35; 95%CI 4.21-15.11), patent ductus arteriosus (OR 4.65 ; 95%CI 1.37-29.11), and other congenital heart diseases except patent ductus arteriosus (OR 3.49; 95%CI 1.57-9.29). The high-risk factors of NEC in premature infants are low birth weight (OR 0.52; 95%CI 0.46-0.59), small gestational age (OR 0.69; 95%CI 0.50-0.77), infection (OR 5.29; 95%CI 3.19～8.42), artificial feeding (OR 1.52; 95%CI 0.75-3.36), feeding increasing speed>20ml/kg.d (OR 4.22;95%CI 2.75-7.84), and congenital heart disease other than patent ductus arteriosus(OR 4.94; 95%CI 2.61-10.41).All had statistical significance (P<0.05).The diagnostic prediction model of NEC was established, which proved that the model fit well(P>0.05)(5)Revealed the high-risk factors for the progress of the stage I of NEC suspected cases to the confirmed cases, including low birth weigh(OR 0.45, 95%CI 0.32～0.64),24 hours after the onset of symptoms and CRP rises above 50mg/L (OR 2.51, 95%CI 1.61～4.47), back to the stomach or vomiting with bile gastric juice (OR 1.61, 95%CI 1.01～4.23), X-ray prompted intestinal thickening (OR 2.17,95%CI 1.69～5.61).Revealed the progress of medical treatment for the implementation of surgical cases of high risk factors are male (OR 2.15, 95%CI 1.10～4.38), small gestational age (OR 0.43 , 95%CI 0.33～0.57) and low birth weight (OR 0.67 , 95%CI 0.61～0.75). All had statistical significance (P<0.05). The progress prediction model of NEC was established, which proved that the model fit well (P>0.05).Conclusion:1.The composition of the population of NEC, the severity of the disease and the related characteristics of the operation mode will change with time.2.The term infants’ NEC is different from the characteristics of premature infants’and they need to be treated differently.3. The establishment of an effective NEC model for the diagnosis of term infants and premature infants has great clinical sense in the early detection and early treatment for high-risk cases.4.It is useful to establish an effective predictive model for NEC progress, so as to prevent the progress of suspected cases to the confirmed case and the medical treatment cases to the operation cases. |
PDF Full Text Request