摘要
目的调查上海地区住院新生儿坏死性小肠结肠炎(NEC)的发生率、病死率和临床特点。方法对2010年1月至2015年12月在复旦大学附属儿科医院住院的623例NEC病例进行回顾性分析。数据统计采用Stata 12.0软件包。结果共纳入623例NEC患儿,早产儿485例(77.8%),包括1期304例,2期176例,3期143例。胎龄(33.2±3.9)周,出生体质量(1 979.7±813.5)g。住院新生儿NEC发生率为1.29%(410/31 662例)。2期和3期NEC发生率为1.01%(319/31 662例)。2期和3期NEC出生体质量和胎龄均明显小于1期NEC,差异均有统计学意义(均P<0.001)。NEC起病前纯母乳喂养比例为7%。1期NEC出生后3 d内预防性应用抗生素治疗和起病前口服布洛芬关闭动脉导管未闭的比例低于2期和3期(P<0.05)。临床表现最常见为腹胀(71.75%,447/623例)、肠鸣音减弱(56.02%,143/623例)、反应差(45.43%,283/623例)和血便(40.45%,252/623例)。早产儿NEC肠穿孔率为17.73%(86/485例),足月儿肠穿孔率为13.04%(18/138例)。NEC手术比率为25.36%。NEC后最常见的并发症为肠狭窄[10.27%(64/623例)]和脓毒症(血培养阳性)[7.87%(49/623例)]。2期和3期NEC白细胞(WBC)<4×109/L和血小板<100×109/L比例均明显高于1期NEC(均P<0.05)。2和3期NEC CRP升高比例及水平高于1期NEC(P<0.05)。抗生素使用依次为甲硝唑(69.34%)、碳青霉烯类(65.65%)、头孢类(61.16%)和青霉素类(58.59%)。治愈出院占65.49%,好转出院19.58%,病死率14.93%,其中3期病死率为45.46%。结论新生儿NEC以胎龄28~34周、出生体质量1 000~1 999 g为主。住院新生儿NEC发生率为1.29%,呈逐年下降趋势,但极低出生体质量儿(VLBW) NEC发生率仍高达11.82%。NEC病死率为14.93%,但3期NEC病死率高达45.46%。
Objective To investigate the incidence, mortality and clinical characteristics of neonatal necroti-zing enterocolitis(NEC) in Shanghai. Methods A retrospective study was conducted in 623 cases of NEC from January 2010 to December 2015 at Children′s Hospital of Fudan University.All analysis were performed by using the statistical software package Stata 12.0. Results Six hundred and twenty-three NEC neonates were included in the study, and 485 of them were preterm infants, including 304 cases of stage 1, 176 cases of stage 2 and 143 cases of stage 3.The gestational age was (33.2±3.9) weeks, and the birth weight was (1 979.7±813.5) g. The incidence of NEC in Children′s Hospital of Fudan University was 1.29%(410/31 662 cases), and that of the stage 2 and stage 3 was 1.01%(319/31 662 cases). The gestational age was smaller and birth weight was less in the stage 2 and stage 3 group than that in the stage 1 group (all P<0.001). The percentage of cases received breast milk feeding was 7%.The rate of prophylactic antibiotics within 3 days of their life and ibuprofen for patent ductus arteriosus prior to NEC in stage 1 group was lower than that in stage-2 and stage 3 groups (all P<0.05). The most common clinical presentations were abdominal distension(71.75%, 447/623 cases), decreased bowel sounds(56.02%, 143/623 cases), looked sick (45.43%, 283/623 cases) and bloody stools(40.45%, 252/623 cases). The bowel perforation rate of the preterm and the term infants was 17.73%(86/485 cases)and 13.04%(18/138 cases), respectively.The patients who received surgical management took up 25.36%.The neonates were most commonly complicated with post-NEC stenosis (10.27%) and a culture-proven sepsis(7.87%). The count of white blood cell (WBC)<4×109/L and platelet<100×109/L raising level in stage 2 and stage 3 were higher than those in stage 1(all P<0.05). The antibiotics used for NEC were metronidazole (69.34%), carbapenems (65.65%), cephalosporins(61.16%) and penicillins(58.59%). The prognosis of NEC showed that cure cases occupie
作者
唐书庆
朱丽
张蓉
钱甜
王瑾
曹云
陈超
Tang Shuqing;Zhu Li;Zhang Rong;Qian Tian;Wang Jin;Cao Yun;Chen Chao(Department of Neonatology, Children′s Hospital of Fudan University, Shanghai 201102, China;Department of Pediatrics, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第15期1171-1175,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
婴儿
新生
婴儿
早产
坏死性小肠结肠炎
影响因素
Infant, newborn
Infant, premature
Necrotizing enterocolitis
Influencing factor
