背景:坏死性小肠结肠炎(NEC)是一种多因素胃肠道疾病,在早产儿中具有高发病率和高死亡率。然而,在中国,关于NEC因素的大样本研究尚未见报道。本Meta分析旨在系统回顾文献,探讨我国早产儿坏死性小肠结肠炎的影响因素,为NEC的预防提供参考。
方法:PubMed,Embase,WebofScience,科克伦图书馆,中国国家知识基础设施(CNKI),中国生物医学文献数据库(CBM),从成立到2023年2月,对万方和VIP数据库进行了系统搜索。我们使用Stata14.0软件进行系统评价和荟萃分析。我们使用具有组合优势比(OR)和95%置信区间(CI)的固定或随机效应模型,使用纽卡斯尔-渥太华量表(NOS)评估质量。
结果:总样本为8616例,其中干预组2456例,对照组6160例。发现16个危险因素和3个保护因素与早产儿坏死性小肠结肠炎有关。败血症(OR=3.91),输血(OR=2.41),新生儿窒息(OR=2.46),肺炎(OR=6.17),感染(OR=5.99),先天性心脏病(OR=4.80),妊娠期肝内胆汁淤积症(ICP)(OR=2.71),机械通气(OR=1.44),妊娠期糖尿病(GDM)(OR=3.08),呼吸窘迫综合征(RDS)(OR=3.28),低蛋白血症(OR=2.80),动脉导管未闭(PDA)(OR=3.10),呼吸衰竭(OR=7.51),严重贫血(OR=2.86),抗生素使用史(OR=2.12),羊水粪染(MSAF)(OR=3.14)是中国早产儿NEC的危险因素。母乳喂养(OR=0.31),口服益生菌(OR=0.36),产前使用糖皮质激素(OR=0.38)是早产儿NEC的保护因素。
结论:败血症,输血,新生儿窒息,肺炎,感染,先天性心脏病,ICP,GDM,RDS,低蛋白血症,PDA,呼吸衰竭,严重贫血,抗生素使用史和MSAF会增加早产儿NEC的风险,而母乳喂养,口服益生菌和产前使用糖皮质激素可降低风险。由于收录文献的数量和质量,上述发现还需要更多高质量研究的进一步验证.
BACKGROUND: Necrotizing enterocolitis (NEC) is a multifactorial gastrointestinal disease with high morbidity and mortality among premature infants. However, studies with large samples on the factors of NEC in China have not been reported. This meta-analysis aims to systematically
review the literature to explore the influencing factors of necrotizing enterocolitis in premature infants in China and provide a reference for the prevention of NEC.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang and VIP databases were systematically searched from inception to February 2023. We used Stata14.0 software to perform the systematic
review and meta-analysis. We used fixed or random effects models with combined odds ratios (ORs) and 95% confidence intervals (CIs), and quality was evaluated using the Newcastle‒Ottawa Scale (NOS).
RESULTS: The total sample was 8616 cases, including 2456 cases in the intervention group and 6160 cases in the control group. It was found that 16 risk factors and 3 protective factors were related to necrotizing enterocolitis in premature infants. Septicemia (OR = 3.91), blood transfusion (OR = 2.41), neonatal asphyxia (OR = 2.46), pneumonia (OR = 6.17), infection (OR = 5.99), congenital heart disease (OR = 4.80), intrahepatic cholestasis of pregnancy (ICP) (OR = 2.71), mechanical ventilation (OR = 1.44), gestational diabetes mellitus (GDM) (OR = 3.08), respiratory distress syndrome (RDS) (OR = 3.28), hypoalbuminemia (OR = 2.80), patent ductus arteriosus (PDA) (OR = 3.10), respiratory failure (OR = 7.51), severe anemia (OR = 2.86), history of antibiotic use (OR = 2.12), and meconium-stained amniotic fluid (MSAF) (OR = 3.14) were risk factors for NEC in preterm infants in China. Breastfeeding (OR = 0.31), oral probiotics (OR = 0.36), and prenatal use of glucocorticoids (OR = 0.38) were protective factors for NEC in preterm infants.
CONCLUSIONS: Septicemia, blood transfusion, neonatal asphyxia, pneumonia, infection, congenital heart disease, ICP, GDM, RDS, hypoproteinemia, PDA, respiratory failure, severe anemia, history of antibiotic use and MSAF will increase the risk of NEC in premature infants, whereas breastfeeding, oral probiotics and prenatal use of glucocorticoids reduce the risk. Due to the quantity and quality of the included literature, the above findings need to be further validated by more high-quality studies.