Risk Factors Related To Prognosis Of Neonatal Necrotizing Enterocolitis

Objective: To analyze risk factors related to prognosis of neonatal necrotizing enterocolitis(NEC) and provide a theoretical basis of determining the severity of the disease and improving prognosis.Methods: 365 newborns with NEC treated at Children's Hospital of Chongqing Medical University from January 2009 to January 2011 were enrolled and analyzed retrospectively. And they were followed up for growth and development more than 3 months after discharge. According to different outcomes they were divided into recovery group and death group. These NEC cases were defined by Bell staging criteria. Risk factors related to prognosis were analyzed by single factor analysis, then above resultes were analyzed by Logistic regression again to find the major risk factors.Results: In all patients, excluding 77 newborns who were failed to follow up, there were 288 effective cases(follow up rate:78.9%). The male to female ratio was 1.4:1. The average birth weight was 2774.67±725.15g. There were 91 preterm infants(31.6%), 190 full term infants(66.0%) and 7 post-term infants(2.4%) diagnosed as NEC. According to Bell stage, there were 209, 47 and 32 cases in stage 1, 2 and 3 respectively. 240 cases (83.3%) were cured, while 48(16.7%) died. 12 cases died in stage 2, among them 11 ceased treatment. Stage 3 had the highest mortality, which was 81.2% (26/32). Single factor analysis found out that the highest dangerous factors which influence the NEC prognosis were: respiratory failure, circulatory failure, sepsis, liver dysfunction, renal dysfunction, intestinal perforation or peritonitis, hyponatremia, lactic acidosis, WBC≤5 or≥20×109/L, CRP≥8g/L, thrombocytopenia, blood transfusions, abdominal distension, bowel sounds decreased or disappeared( P < 0.05). TheⅠ,ⅡorⅢstage of abdominal X-ray was 213, 22, 22 cases respectively. In this study in NEC confirmed cases, X-ray appeared stageⅡwas 27.8%(22/79)andⅢwas 27.8%(22/79)(χ2=102.36,P<0.001). Logistic regression analysis showed that respiratory failure,renal dysfunction,intestinal perforation or peritonitis, WBC≤5 or≥20×109/L, thrombocytopenia, bowel sounds decreased or disappeared were the major risk factors for NEC related to death.Conclusion: Respiratory failure, renal dysfunction, intestinal perforation or peritonitis, WBC≤5 or≥20×109/L, thrombocytopenia, bowel sounds decreased or disappeared are the major risk factors related to prognosis of NEC. Avoiding these risk factors and effectively preventing as well as treating complications of NEC can control progression, reduce mortality and improve prognosis.