Clinical Analysis Of Surgery For Neonatal Necrotizing Enterocolitis

Objective: Through the retrospective analysis of epidemiological trends,clinical features and prognostic risk factors for surgical cases of neonatal necrotizing enterocolitis(NEC)in our hospital.to provide evidence-based support for early detection,early diagnosis and effective treatment of neonatal necrotizing enterocolitis(NEC)Methods: 137 severe surgical cases of neonatal necrotizing enterocolitis in Guangdong children's hospital from January 2014 to December 2019 were recruited in this study.They were divided into preterm infants and term infants,and further respectively divided into death groups and survival groups,Then we made a comparison of general factors,perinatal factors,clinical manifestation,relevant examination,common complications and outcome between them,The quantitative data were expressed with mean±standard deviation(X±S),and the qualitative data were expressed as percentage of cases(%).The comparison between groups were using the chi-square test and multivariate Logistic regression analysis.Results:1.Epidemiological trends: the prevalence of NEC in our hospital from 2014 to 2019 were 2.94%,3.45%,3.99%,4.01%,4.53% and 4.14%,showing a rising trend.The incidence of surgical NEC were 12.7%,9.21%,6.71%,6.63%,6.50% and 7.27%,showing a decreasing trend.According to the comparison of different birth weight groups,it has the higher mortality when the birth weight low.2.Age of onset: the age of onset were 14.45±8.34 days in the preterm infant group and 5.39±5.82 days in the term infant group.3.Diseased region: the lesions were mainly occur in these positions:terminal ileum 78 cases(56.93%),ileocecal region 47 cases(34.31%),ascending colon 41 cases(29.93%),transverse colon 26 cases(18.98%),and total intestine 2 cases(1.46%).4.The incidence of asphyxia,fetal distress,antenatal infection,meconium stained amniotic fluid and premature rupture of membranes in the preterm death group were higher than the preterm survival group,but the difference between groups were not statistically significant(P >0.05).5.Clinical manifestations: the incidence of abdominal distension,vomiting and blood stool were higher in the term infant group,which hade the typical gastrointestinal symptoms.the incidence of abdominal distension,drowsiness and apnea were higher in the preterm infant group,which hade more atypical gastrointestinal symptoms,umbilical vein catheterization and red blood cell transfusion before onset.6.Risk factors influence the outcome of severe surgical NEC in preterm infant were gestational age,birth weight,red blood cell transfusion before onset,umbilical vein catheter,C-reactive protein,hemoglobin,platelet,metabolic acidosis,X-ray sign pneumoperitoneum,respiratory distress syndrome and multiple organ dysfunction syndrome,sepsis,septic shock and cerebroventricular heaemorrhage.Risk factors influence the outcome of severe surgical NEC in term infant were neonatal infections,metabolic acidosis,pneumoperitoneum.Further Logistic analysis,C-reactive protein elevation,multi-organ dysfunction syndrome and septic shock were the independent risk factors,while breast-feeding was a protective factor for the clinical outcome in premature infant.Conclusion:1.The prevalence of NEC in our hospital has generally increased in the past 6 years;The incidence of severe surgical NEC was decreasing.It has the higher mortality when the birth weight low;2.The age of onset in full-term infants was earlier than that in premature infants,operation found that lesions were mainly occur in terminal ileal lesions,followed by ileocecal region and ascending colon,rare happened for total intestine;3.Abdominal distension was common during the course of NEC,term infant hade the typical gastrointestinal symptoms,while preterm infant group hade more atypical gastrointestinal symptoms,umbilical vein catheterization and red blood cell transfusion before onset;4.Risk factors influence the outcome of severe surgical NEC in term infant were neonatal infections,metabolic acidosis,pneumoperitoneum;5.gestational age,birth weight,red blood cell transfusion before onset,umbilical vein catheter,C-reactive protein,hemoglobin,platelet,metabolic acidosis,X-ray sign pneumoperitoneum,respiratory distress syndrome and multiple organ dysfunction syndrome,sepsis,septic shock and cerebroventricular heaemorrhage were the main risk factors for the outcome of severe surgical NEC in preterm infant.C-reactive protein elevation,multi-organ dysfunction syndrome and septic shock were the independent risk factors,while breast-feeding was a protective factor for the clinical outcome in premature infant.