Clinical characteristics and prognosis of necrotizing enterocolitis in preterm infants with gestational age <34 weeks / 中国新生儿科杂志

ABSTRACT

Objective:To study the clinical characteristics and prognosis of necrotizing enterocolitis (NEC) in preterm infants with gestational age (GA) <34 weeks.Methods:From January 2016 to December 2022, preterm infants (GA <34 weeks) with NEC (Bell's stage Ⅱ/Ⅲ) admitted to our hospital were retrospectively analyzed. They were assigned into the conservative group and the surgical group. The perinatal data, clinical characteristics, laboratory results and prognosis were compared between the two groups.Results:A total of 4 526 preterm infants were enrolled. 298 (6.6%) had NEC and 188 were in stage Ⅱ/Ⅲ. 38(20.2%) infants received surgery and the remaining 150 were treated conservatively. Comparing with the conservative group, the surgical group showed higher incidences of the following: small for gestational age, blood in stool or positive fecal occult blood test (FOBT), apnea, poor response, increased heart rate, leukocytosis or leukopenia, thrombocytopenia, mechanical ventilation and elevated C-reactive protein and procalcitonin (all P<0.05). The surgical group also had higher incidences of concomitant shock and need for mechanical ventilation at the time of NEC diagnosis ( P<0.05). During NEC treatment, the surgical group had higher incidence of infectious pneumonia ( P=0.031). At 1, 3, 6, 12 and 18 months of follow-up, the surgical group had higher incidences of insufficient body weight gain ( P<0.05). At 1, 3 and 6 months of follow-up, the surgical group had higher incidences of smaller head circumference ( P<0.05). At 1 and 3 months of follow-up, the surgical group had higher incidences of shorter body length ( P<0.05). However, no significant differences existed in head circumference and body length as age developed ( P>0.05). At 12 months follow-up, no significant difference existed in the incidence of cerebral palsy between the two groups ( P>0.05). Conclusions:Blood in stool or positive FOBT, apnea, poor response and increased heart rate are common in GA <34 weeks preterm infants with NEC. Early diagnosis and identification of those requiring surgery are important. After surgery and later on, the infants may have a catch-up growth with the growth rate of head circumference and body length more pronounced than body weight.