早产儿坏死性小肠结肠炎合并宫外发育迟缓临床特点及危险因素分析  

Clinical features and risk factors of necrotizing enterocolitis complicated with extrauterine growth retardation in premature infants

作　　者：马丽丽[1] 袁芮 锡洪敏[1] 李向红[1] 姜红[1] 李亮亮[1] 尹向云[1] 杨萍[1] 张璐璐 Ma Lili;Yuan Rui;Xi Hongmin;Li Xianghong;Jiang Hong;Li Liangliang;Yin Xiangyun;Yang Ping;Zhang Lulu(Department of Neonatology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院新生儿科,青岛266000

出　　处：《中华新生儿科杂志（中英文）》2024年第10期587-591,共5页Chinese Journal of Neonatology

摘　　要：目的探讨早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)合并宫外发育迟缓(exterine growth retardation,EUGR)的临床特点和高危因素。方法选择2014年1月至2022年2月青岛大学附属医院新生儿科收治的NEC早产儿进行回顾性分析,根据出院时是否合并EUGR分为EUGR组和非EUGR组,比较两组患儿的临床资料,并进一步分析NEC合并EUGR的高危因素。结果共纳入NEC早产儿101例,EUGR组62例(61.4%),非EUGR组39例(38.6%)。EUGR组胎龄[(31.0±0.4)周比(32.5±0.4)周]、出生体重[(1447±72)g比(1844±99)g]低于非EUGR组,小于胎龄儿比例(21.0%比7.7%)高于非EUGR组,NEC发病日龄[(20.5±1.5)d比(12.3±1.0)d]晚于非EUGR组;EUGR组发病前48 h内输注红细胞(32.3%比10.3%)、动脉导管未闭(27.4%比7.7%)、新生儿呼吸窘迫综合征(80.6%比38.5%)、喂养不耐受(64.5%比43.6%)比例高于非EUGR组;发病后EUGR组肠切除(22.6%比10.3%)、肠外营养时间[(25.9±1.7)d比(18.9±1.4)d]、母乳喂养(40.3%比17.9%)、合并败血症(71.0%比43.6%)比例高于非EUGR组,体重增长速率[(11.4±2.1)g/(kg·d)比(13.3±2.4)g/(kg·d)]低于非EUGR组,差异均有统计学意义(P<0.05)。Logistic回归分析显示小于胎龄儿(OR=8.682,95%CI 1.583~47.613,P=0.013)、动脉导管未闭(OR=5.071,95%CI 1.153~22.296,P=0.032)、发病前48 h内输注红细胞(OR=5.601,95%CI 1.139~27.541,P=0.034)、肠切除(OR=10.135,95%CI 2.172~47.302,P=0.003)、肠外营养时间(OR=1.046,95%CI 1.002~1.093,P=0.039)是NEC患儿合并EUGR的独立危险因素。结论NEC早产儿易合并EUGR,小于胎龄儿、动脉导管未闭、发病前48 h内输注红细胞、肠切除是NEC早产儿发生EUGR的独立危险因素。ObjectiveTo study the clinical features and risk factors of extrauterine growth retardation(EUGR)in premature infants with necrotizing enterocolitis(NEC).MethodsFrom January 2014 to February 2022,premature infants with NEC admitted to the neonatal department of our hospital were retrospectively analyzed.The infants were assigned into EUGR group and non-EUGR group according to the diagnosis at discharge.Clinical data of the two groups were compared and risk factors of NEC with EUGR were further analyzed.ResultsA total of 101 cases were enrolled,62 NEC patients(61.4%)were included in the EUGR group and 39(38.6%)in the non-EUGR group.The EUGR group had significantly lower mean gestational age and body weight,higher incidence of small-for-gestational-age(SGA)and older age of NEC onset than the non-EUGR group(all P<0.05).The EUGR group had higher incidences of red blood cell(RBC)transfusion within 48 h before NEC onset(32.3%vs.10.3%),patent ductus arteriosus(PDA)(27.4%vs.7.7%),neonatal respiratory distress syndrome(80.6%vs.38.5%)and feeding intolerance(64.5%vs.43.6%)than the non-EUGR group.After the onset of NEC,the EUGR group had higher rates of intestinal resection(22.6%vs.10.3%),breastfeeding(40.3%vs.17.9%),sepsis(71.0%vs.43.6%)and longer duration of parenteral nutrition(PN)[(25.9±1.7)d vs.(18.9±1.4)d]than the non-EUGR group,while weight gain[(11.4±2.1)g/(kg·d)vs.(13.3±2.4)g/(kg·d)]was lower than the non-EUGR group.Multivariate logistic regression analysis showed that SGA(OR=8.682,95%CI 1.583-47.613,P=0.013),PDA(OR=5.071,95%CI 1.153-22.296,P=0.032),RBC transfusion(OR=5.601,95%CI 1.139-27.541,P=0.034),enterectomy(OR=10.135,95%CI 2.172-47.302,P=0.003)and PN duration(OR=1.046,95%CI 1.002-1.093,P=0.039)were independent risk factors for EUGR in premature infants with NEC.ConclusionsEUGR is common in premature infants with NEC.SGA,PDA,RBC transfusion within 48 h before NEC onset and enterectomy are independent risk factors for EUGR.

关 键 词：早产儿 坏死性小肠结肠炎 宫外发育迟缓 高危因素 

分 类 号：R722.6[医药卫生—儿科]