Abstract：
The threshold for active management of babies born prematurely in the UK is currently 22 weeks. The optimal management strategy for necrotising enterocolitis (NEC) in babies born at or near this threshold remains unclear.
To review our institutional experience of babies born <24 weeks diagnosed with NEC, identify risk factors for NEC, and compare outcomes with a control cohort.
All infants born <24 weeks gestation January 2015-December 2021 were identified. Babies diagnosed with NEC were defined as cases and babies with no NEC diagnosis as controls. Patient demographics, clinical features, complications and outcomes were extracted from the medical record and compared between cases and controls.
Of 56 babies, 31 (55.3%) were treated for NEC. There was no difference in NEC-specific risk factors between cases and controls. 17 babies (30.4%) underwent surgery, of these, 11/17 (64.7%) presented with a C reactive protein rise and 11/17 (64.7%) a fall in platelet count. Pneumatosis intestinalis (3/17 (17.7%)) or pneumoperitoneum (3/17 (17.7%)) were present in only a minority of cases. Abdominal ultrasound demonstrated intestinal perforation in 8/8 cases. The surgical complication rate was 5/17 (29.4%). There was no difference in the incidence of intraventricular haemorrhage, periventricular leukomalacia and survival to discharge between the groups.
The diagnosis of NEC in infants born <24 weeks gestation is challenging with inconsistent clinical and radiological features. Ultrasound scanning is a useful imaging modality. Mortality was comparable regardless of a diagnosis of NEC. Low gestational age is not a contraindication to surgical intervention in NEC.
To review our institutional experience of babies born <24 weeks diagnosed with NEC, identify risk factors for NEC, and compare outcomes with a control cohort.
All infants born <24 weeks gestation January 2015-December 2021 were identified. Babies diagnosed with NEC were defined as cases and babies with no NEC diagnosis as controls. Patient demographics, clinical features, complications and outcomes were extracted from the medical record and compared between cases and controls.
Of 56 babies, 31 (55.3%) were treated for NEC. There was no difference in NEC-specific risk factors between cases and controls. 17 babies (30.4%) underwent surgery, of these, 11/17 (64.7%) presented with a C reactive protein rise and 11/17 (64.7%) a fall in platelet count. Pneumatosis intestinalis (3/17 (17.7%)) or pneumoperitoneum (3/17 (17.7%)) were present in only a minority of cases. Abdominal ultrasound demonstrated intestinal perforation in 8/8 cases. The surgical complication rate was 5/17 (29.4%). There was no difference in the incidence of intraventricular haemorrhage, periventricular leukomalacia and survival to discharge between the groups.
The diagnosis of NEC in infants born <24 weeks gestation is challenging with inconsistent clinical and radiological features. Ultrasound scanning is a useful imaging modality. Mortality was comparable regardless of a diagnosis of NEC. Low gestational age is not a contraindication to surgical intervention in NEC.
摘要：
背景：积极管理英国早产婴儿的阈值目前为22周。在此阈值或附近出生的婴儿中，坏死性小肠结肠炎（NEC）的最佳管理策略尚不清楚。
目的：回顾我们对出生<24周的婴儿诊断为NEC的机构经验，确定NEC的风险因素，并将结果与对照组进行比较。
方法：确定所有出生在妊娠24周以下的婴儿2015年1月至2021年12月。被诊断为NEC的婴儿被定义为病例，没有NEC诊断的婴儿被定义为对照。患者人口统计学，临床特征,从病历中提取并发症和结局,并在病例和对照组之间进行比较.
结果：在56个婴儿中，31例（55.3%）接受NEC治疗。病例和对照组之间NEC特异性危险因素没有差异。17名婴儿(30.4%)接受了手术，其中，11/17（64.7％）表现为C反应蛋白升高和11/17（64.7％）血小板计数下降。仅在少数病例中存在肠气（3/17（17.7％））或气腹（3/17（17.7％））。8例腹部超声显示肠穿孔。手术并发症发生率为5/17(29.4%)。脑室内出血的发生率没有差异，两组之间的脑室周围白质软化和存活出院。
结论：在妊娠24周以下出生的婴儿中诊断NEC具有挑战性，其临床和放射学特征不一致。超声扫描是一种有用的成像模态。无论是否诊断为NEC，死亡率均具有可比性。低胎龄不是NEC手术干预的禁忌症。
目的：回顾我们对出生<24周的婴儿诊断为NEC的机构经验，确定NEC的风险因素，并将结果与对照组进行比较。
方法：确定所有出生在妊娠24周以下的婴儿2015年1月至2021年12月。被诊断为NEC的婴儿被定义为病例，没有NEC诊断的婴儿被定义为对照。患者人口统计学，临床特征,从病历中提取并发症和结局,并在病例和对照组之间进行比较.
结果：在56个婴儿中，31例（55.3%）接受NEC治疗。病例和对照组之间NEC特异性危险因素没有差异。17名婴儿(30.4%)接受了手术，其中，11/17（64.7％）表现为C反应蛋白升高和11/17（64.7％）血小板计数下降。仅在少数病例中存在肠气（3/17（17.7％））或气腹（3/17（17.7％））。8例腹部超声显示肠穿孔。手术并发症发生率为5/17(29.4%)。脑室内出血的发生率没有差异，两组之间的脑室周围白质软化和存活出院。
结论：在妊娠24周以下出生的婴儿中诊断NEC具有挑战性，其临床和放射学特征不一致。超声扫描是一种有用的成像模态。无论是否诊断为NEC，死亡率均具有可比性。低胎龄不是NEC手术干预的禁忌症。
