Objective To observe the difference on clinical characteristics between small for gestational age(SGA) and appropriate for gestational age(AGA) infants with necrotizing enterocolitis(NEC),so as to provide evidence for the prevention of NEC. Methods A total of 236 cases with NEC(stage Ⅱand Ⅲ) hospitalized from January 1st,2014 to December 31th,2018 were enrolled in this study,and were divided into SGA group(55 cases) and AGA group(181 cases).The differences on clinical characteristics between the two groups were analyzed. Results 1) The proportions of cesarean section(83.6%vs.59.7%),maternal hypertention during pregnancy(56.4% vs.24.9%) and fetal distress(32.7% vs.11.6%)in SGA group were significantly higher than those in AGA group(P＜0.05).2) The proportions of clinical stage Ⅲ(41.8% vs.26.5%) and poor prognosis(abandonment and death)(25.5% vs.13.3%) of AGA were significantly higher than those of AGA,and the hospitalization duration[25(16,23) vs.17(12,24)] of SGA was significantly longer than that of AGA(P<0.05).There were no significant differences on the age of start feeding,the onset of NEC,the ratio of RBC transfusion within 72 hours before the onset of NEC,the levels of WBC,CRP and PLT,the positive rate of etiological examination(stool culture and blood culture) and the number of cases of surgical treatment between SGA and AGA groups(P＞0.05).Logistic regression analysis showed that the risk factors for the poor prognosis of SGA included clinical stage Ⅲ of NEC(OR=15.211,95%CI:2.998-26.107),sepsis after diagnosis of NEC(OR=10.440,95%CI:1.627-19.377),shock(OR=12.256,95%CI:2.896-21.058) and intestinal perforation(OR=6.305,95%CI:1.473-8.240).Meanwhile,risk factors for the poor prognosis of AGA were clinical stage Ⅲof NEC(OR=13.352,95%CI:1.866-18.540),sepsis after diagnosis of NEC(OR=9.662,95%CI:2.508-16.004) and shock(OR=11.254,95%CI:2.183-17.005). Conclusions NEC in SGA infants is more serious than that in AGA,and the prognosis is poorer in SGA infants.Thus,complications after NEC should be treated actively in order to reduce the mortality.
Key words
small for gestational age /
appropriate for gestational age /
necrotizing enterocolitis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Neu J.Necrotizing enterocolitis:the mystery goes on[J].Neonatology,2014,106(4):289-295.
[2] Younge N,Goldstein RF,Bann CM,et al.Survival andneurodevelopmental outcomes among periviable infants[J].N Engl J Med,2017,376(7):617-628.
[3] 林慧佳,施丽萍,杜立中.新生儿坏死性小肠结肠炎患儿的远期预后[J].中国当代儿科杂志,2018,20(12):985-989.
[4] Ree IM,Smits-Wintjens VE,Rijntjes-Jacobs EG,et al.Necrotizing enterocolitis in small-for-gestational-age neonates:a matched case-control study[J].Neonatology,2014,105(1):74-78.
[5] Qian T,Zhang R,Zhu L,et al.Necrotizing enterocolitis in low birth weight infants in China:mortality risk factors expressed by birth weight categories[J].Pediatr Neonatol,2017,58(6):509-515.
[6] 邵肖梅,叶鸿瑁,丘小汕.《实用新生儿学》[M].4版.北京:人民卫生出版社,2011:46-578.
[7] Hector MF,Truong VT,Claudia P.Morbidity and mortality in small-for-gestational age infants:a secondary analysis of nine MFMU network studies[J].Am J Perinatol,2017,34(4):323-332.
[8] 余敏,肖志辉.新生儿坏死性小肠结肠炎的临床高危因素分析[J].中华临床医师杂志:电子版,2013,7(19):8653-8657.
[9] Neu J.Dysbiosis in the neonatal period:role of cesarean section[J].Nestle Nutr Inst Workshop Ser,2017,88:57-66.
[10] Wagneer CL,Taylor SN,Johnson D.Host factors in amniotic fluid and breast milk that contribute to gut maturation.Clin Rev Allergy Immunol,2008,34(2):191-204.
[11] Arnon S,Sulam D,Konikoff F,et al.Very early feeding in stable small for gestational age preterm infants:a randomized clinical trial[J].J Pediatr(Rio J),2013,89(4):388-393.
[12] 汪莉,倪申旺,朱克然,等.C-反应蛋白、降钙素原在新生儿坏死性小肠结肠炎患儿的水平变化及临床意义[J].中国当代儿科杂志,2018,20(10):825-830.
[13] 于论,孙斌,缪珀,等.82例新生儿坏死性小肠结肠炎预后危险因素分析[J].中国当代儿科杂志,2013(12):1082-1085.
[14] Zhang Y,Ma JK,Wei H,et al.Predictive scores for mortality in full-term infants with necrotizing enterocolitis:experience of a tertiary hospital in Southwest China [J].World J Pediatr,2016,12(2):202-208.
[15] Lauren KB,Barbara BW,Phillip IT,et al.Independence of gut bacterial content and neonatal necrotizing enterocolitisseverity[J].J Pediatr Surg,2017,52:993-998.
[16] 钟颖,余加林.新生儿坏死性小肠结肠炎并发败血症临床分析[J].重庆医科大学学报,2013,38(10):1199-1203.
[17] 曾德峰,谭忠友.新生儿坏死性小肠结肠炎的高危因素及外科治疗预后影响因素的研究[J].重庆医科大学学报,2017,42(3):361-364.
PDF(649 KB)
