背景:坏死性小肠结肠炎(NEC)是一种严重的胃肠道疾病,主要影响早产新生儿,并在生命的7天后发生(迟发性NEC,LO-NEC)。不幸的是,在过去的几十年里,在治疗或预防方面没有取得太大进展。本研究旨在分析LO-NEC的危险因素,以及LO-NEC对极早产儿(VPIs)短期结局的影响,重点是营养和不同的发病时间。
方法:回顾性收集了2019年9月至2020年12月中国7个不同地区的28家医院的VPI的临床数据。将2509例登记的VPI分为2组:LO-NEC组和非LO-NEC组。根据起效时间将LO-NEC组分为2个亚组:LO-NEC发生在8〜14d组之间,LO-NEC发生在14d组之后。临床特征,营养状况,并对这些组的短期临床结局进行分析和比较.
结果:与非LO-NEC组相比,LO-NEC组贫血比例较高,输血,和有创机械通气(IMV)治疗前NEC;LO-NEC组婴儿禁食时间较长,需要更长的持续时间才能达到目标总热量摄入(110千卡/千克)并恢复出生体重,体重增长速度较慢;出生后第一周中链和长链甘油三酯(MCT/LCT)乳剂摄入量的累积剂量较高,母乳喂养率较低。此外,类似的结果,包括更高的IMV比例,较低的母乳喂养率,更多MCT/LCT乳剂摄入量,与14d后的LO-NEC组相比,LO-NEC组的生长速度在8〜14d之间也较慢(均(P<0.05)。在对混杂因素进行调整后,母乳喂养比例高被确定为保护因素,NEC前禁食时间长被确定为LO-NEC的危险因素;早期喂养被确定为保护因素和低胎龄,III~IV级新生儿呼吸窘迫综合征(NRDS),在第1周MCT/LCT乳剂的高积累被确定为发生在8~14d之间的LO-NEC的危险因素。Logistic回归分析显示LO-NEC是晚发型脓毒症的危险因素,肠外营养相关性胆汁淤积,早产儿代谢性骨病,和宫外发育迟缓。
结论:积极预防早产,规范治疗III~IV级NRDS,优化肠内和肠外营养策略可能有助于降低LO-NEC的风险,尤其是发生在8~14d之间的,这可能进一步改善VPI的短期临床结局。
背景:ChiCTR1900023418(26/05/2019)。
BACKGROUND: Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease, primarily affects preterm newborns and occurs after 7 days of life (late-onset NEC, LO-NEC). Unfortunately, over the past several decades, not much progress has been made in its treatment or prevention. This study aimed to analyze the risk factors for LO-NEC, and the impact of LO-NEC on short-term outcomes in very preterm infants (VPIs) with a focus on nutrition and different onset times.
METHODS: Clinical data of VPIs were retrospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. A total of 2509 enrolled VPIs were divided into 2 groups: the LO-NEC group and non-LO-NEC group. The LO-NEC group was divided into 2 subgroups based on the onset time: LO-NEC occurring between 8 ~ 14d group and LO-NEC occurring after 14d group. Clinical characteristics, nutritional status, and the short-term clinical outcomes were analyzed and compared among these groups.
RESULTS: Compared with the non-LO-NEC group, the LO-NEC group had a higher proportion of anemia, blood transfusion, and invasive mechanical ventilation (IMV) treatments before NEC; the LO-NEC group infants had a longer fasting time, required longer duration to achieve the target total caloric intake (110 kcal/kg) and regain birthweight, and showed slower weight growth velocity; the cumulative dose of the medium-chain and long-chain triglyceride (MCT/LCT) emulsion intake in the first week after birth was higher and breastfeeding rate was lower. Additionally, similar results including a higher proportion of IMV, lower breastfeeding rate, more MCT/LCT emulsion intake, slower growth velocity were also found in the LO-NEC group occurring between 8 ~ 14d when compared to the LO-NEC group occurring after 14 d (all (P < 0.05). After adjustment for the confounding factors, high proportion of breastfeeding were identified as protective factors and long fasting time before NEC were identified as risk factors for LO-NEC; early feeding were identified as protective factors and low gestational age, grade III ~ IV neonatal respiratory distress syndrome (NRDS), high accumulation of the MCT/LCT emulsion in the first week were identified as risk factors for LO-NEC occurring between 8 ~ 14d. Logistic regression analysis showed that LO-NEC was a risk factor for late-onset sepsis, parenteral nutrition-associated cholestasis, metabolic bone disease of prematurity, and extrauterine growth retardation.
CONCLUSIONS: Actively preventing premature birth, standardizing the treatment of grade III ~ IV NRDS, and optimizing enteral and parenteral nutrition strategies may help reduce the risk of LO-NEC, especially those occurring between 8 ~ 14d, which may further ameliorate the short-term clinical outcome of VPIs.
BACKGROUND: ChiCTR1900023418 (26/05/2019).