ABSTRACT
OBJECTIVE: We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC. METHODS: Retrospective comparison of clinical information between Group Aâ=âintestinal failure (Parenteral nutrition (PN) >90 days) and death and Group Bâ=âsurvivors and with PN dependenceâ<â90 days in preterm infants with surgical NEC. RESULTS: Group A (nâ=â99/143) had a lower mean gestational age (26.4 weeks [SD3.5] vs. 29.4 [SD 3.5]; pâ=â0.013), lower birth weight (873 gm [SD 427g] vs. 1425 gm [894g]; pâ=â<0.001), later age of NEC onset (22 days [SD20] vs. 16 days [SD 17]; pâ=â0.128), received surgery later (276 hours [SD 544] vs. 117 hours [SD 267]; pâ=â0.032), had cholestasis, received dopamine (80.6% vs. 58.5%; pâ=â0.010) more frequently and had longer postoperative ileus time (19.8 days [SD 15.4] vs. 11.8 days [SD 6.5]; pâ=â<0.001) and reached full feeds later (93 days [SD 45] vs. 44 [SD 22]; pâ=â<0.001) than Group B.On multivariate logistic regression, higher birth weight was associated with lower risk (OR 0.35, 95% CI 0.15-0.82; pâ=â0.016) of TPNâ>â90 days or death. Longer length of bowel resected (OR 1.76, 95% CI 1.02-3.02; pâ=â0.039) and longer postoperative ileus (OR 2.87, 95% CI 1.26-6.53; pâ=â0.011) were also independently associated with TPN >90days or death adjusted for gestational age and antenatal steroid treatment. CONCLUSION: In preterm infants with surgical NEC, clinical factors such as lower birth weight, longer bowel loss, and postoperative ileus days were significantly and independently associated with TPN >90 days or death.
Subject(s)
Enterocolitis, Necrotizing , Ileus , Infant, Newborn, Diseases , Intestinal Failure , Pregnancy , Infant , Infant, Newborn , Female , Humans , Infant, Premature , Birth Weight , Enterocolitis, Necrotizing/epidemiology , Enterocolitis, Necrotizing/surgery , Retrospective Studies , Ileus/epidemiologyABSTRACT
OBJECTIVE: We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC). METHODS: A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology. RESULTS: The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 %; pâ=â0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; pâ=â0.034), lost more bowel length (pâ=â0.045), had higher CRP levels at 2 weeks (pâ=â0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; pâ=â0.014) than mild/moderate (Grade 0-2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; pâ=â<0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; pâ=â0.037), higher neovascularization (pâ=â0.01), higher fibroblasts (pâ=â0.023) and higher lymphocyte percentages up to 48 hours (pâ<â0.05) following NEC than mild/ moderate hemorrhage group.On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05-0.58]; pâ=â0.005), higher inflammation (OR 3.7 [95% CI 2.09-7.32]; pâ=â0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02-1.11]; pâ=â0.005) were independently associated with a higher odd of severe intestinal hemorrhage. CONCLUSION: The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling.