| ObjectiveThrough analyzing the clinical data of their mothers and children of necrotizing enterocolitis(NEC),to explore the differences in pathogenesis factors related to different gestational ages,birth weight,the stage of NEC and blood transfusion,which provides a clinical reference for the prevention and treatment of NEC.MethodsThis study retrospectively collected the data of those neonates who was hospitalized in the neonatology department of the Third Affiliated Hospital of Guangzhou Medical University from October 1,2017 to September 30,2021 and was clinically diagnosed NEC(stage II-III),as well as the delivery data of their mothers.According to the gestational age,birth weight,modified Bell stage of NEC,and whether blood transfusion was associated,the neonates were divided into the gestational age≥32w group(39 cases)and the gestational age <32w group(57 cases),≥1500g group(44 cases)and <1500g group(52 cases),stage II group(57 cases)and stage III group(39 cases),blood transfusion associated NEC group(9 cases)and nontransfusion associated NEC group(87 cases),and the differences of relevant clinical factors between the groups were analyzed by case-control study method.ResultsA total of 96 cases with clinically diagnosed NEC were included in the analysis,with the mean gestational age was 30.9±3.3 weeks and the median birth weight was1450(1090,1880)g.The mortality rate of gestational age≥ 32 w group during hospitalization [0.0%(0/39)v.s.19.3%(11/57),P=0.014] were higher than the gestational age<32 w group’s,received UAC [0.0%(0/39)v.s.47.4%(27/57),P<0.001],UVC [38.5%(15/39)v.s.94.7%(54/57),P<0.001] were higher than that in the gestational age < 32 w group,the incidence of NRDS was lower than that in the gestational age < 32 w group [35.9%(14/39)v.s.98.2%(56/57),P<0.001],the mean number of platelets in the early onset of the NEC [(280.00± 104.60)×10^9/L v.s.(264.70±127.00)×10^9/L,P<0.001],median hemoglobin in the early onset of the NEC [140.50(122.80～161.50)g/L v.s.105.00(93.00～122.00)g/L,P<0.001] were higher than those gestational age <32w group,and those mothers who were treated with magnesium sulfate before delivery [46.2%(18/39)v.s.80.7%(46/57),P<0.001],full course of glucocorticoid therapy [10.3%(4/39)v.s.28.1%(16/57),P=0.035] were lower than those in the gestational age < 32 w group;The mortality during hospitalization of neonates with NEC whose birth weight ≥1500 g [0.0%(0/44)v.s.21.2%(11/52),P=0.001] was lower than that in the birth weight < 1500 g group,received UAC [6.8%(3/44)v.s.46.2%(24/52),P<0.001],UVC [38.6%(17/44)v.s.100.0%(52/52),P<0.001] were lower than those in the birth weight < 1500 g group,the incidence of NRDS [40.9%(18/44)v.s.100.0%(52/52),P<0.001] was lower than those in the birth weight < 1500 g group,and the median hemoglobin [ 137.00(111.00,159.00)g/L v.s.104.0(93.50,119.80)g/L,P<0.001] was higher than the birth weight<1500 g group,the proportion of prenatal to use magnesium sulfate [47.7%(21/44)v.s.82.7%(43/52),P<0.001],full course of glucocorticoids [6.8%(3/44)v.s.32.7%(17/52),P=0.002] were lower than the birth weight < 1500 g group.The proportion of deaths during hospitalization in stage II of NEC [3.5%(2/57)v.s.23.1%(9/39),P=0.009] was lower than that of NEC stage III group,the median birth weight of neonates in stage II was greater than the NEC stage III group [1540(1196,1898)g v.s.1090(840,1840)g,P=0.006],and the median lymphocyte percentage in stage II in the early onset of the NEC [31.80%(22.00%,42.60%)v.s.17.90%(13.70%,24.30%),P<0.001],mean platelet count [(295.10±120.60)×10^9/L v.s.(234.80±105.40)×10^9/L,P=0.014] was greater than that of NEC stage III group,and the proportion of their mothers with gestational diabetes mellitus in stage II [15.8%(9/57)v.s.33.3%(13/39),P=0.045] was lower than that in stage III NEC group.The proportion of stage III NEC in the transfusion associated NEC group [77.8%(7/9)versus 36.8%(32/87),P=0.043],the mortality during hospitalization in the transfusion associated NEC group [55.6%(5/9)versus 6.9%(6/87),P<0.001] were higher than those in nontransfusion associated NEC,the mean gestational age of neonates in the transfusion associated NEC group [(27.80±2.16)w v.s.(31.24±3.19)w,P=0.002] and median birth weight [910g(750,1228)g v.s.1475g(1090,1913)g,P=0.003] were smaller than those who were in the non-transfusion associated NEC group.Multivariate regression analysis showed that transfusion of concentrated red blood cells within 48 hours before onset was an independent risk factor for stage III of NEC,and elevated lymphocyte percentage in the early onset of NEC was a protective factor(P<0.05).ConclusionsThose neonates who were diagnosed NEC,were different in inpatient outcomes and clinically relevant risk factors between the groups with different gestational ages at birth,different birth weights,different clinical stages,and whether or not blood transfusions were related.Compared with stage II NEC,red blood cell transfusion within 48 hours before the onset of disease might be a risk factor for neonatal stage III NEC,and the elevated lymphocyte percentage in the early onset might be a protective factor.Compared with non-transfusion related NEC,transfusion associated NEC is mainly in stage III and had a higher mortality rate. |
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