Broad-Spectrum Antibiotics Plus Metronidazole May Not Prevent The Deterioration Of Necrotizing Enterocolitis From Stage â…¡ To â…¢ In Full-Term And Near-Term Infants:a Retrospective Cohort Study

Objectives:To evaluate the effect of broad-spectrum antibiotic plus metronidazole on preventing the deterioration of necrotizing enterocolitis (NEC) from stage Ⅱ to Ⅲ in full-term and near-term infants.Methods:A retrospective cohort study based on the propensity score (PS) 1:1 matching was performed among the full-term and near-term infants with NEC (Bell’s stage> Ⅱ). All infants who received broad-spectrum antibiotics were divided into two groups:with metronidazole group (metronidazole was used≥ 4 days continuously, 15mg/kg.d) and without metronidazole group (metronidazole was not used). The depraved rates of stage Ⅱ NEC between two groups were compared. Meanwhile, the risk factors associated with the deterioration of stage Ⅱ NEC were analyzed by case-control study in the PS-matched cases.Results:A total of 229 infants met the inclusion criteria. After PS-matching, seventy-three pairs were matched, and the depraved rate of NEC in with metronidazole group was not lower than that in without metronidazole group (15.1% vs.8.2%, P=0.197). Binary logistic regression analysis showed that sepsis post NEC [OR:3.748,95%C7: 1.171-11.998, P=0.026], and needing to use transfusion of blood products (cryoprecipitation, plasma) after diagnosis of NEC [OR:8.003,95%C7: 2.365-27.087, P=0.001] were the independent risk factors for stage Ⅱ progressing to stage Ⅲ, and longer time for first nasogastric suction was a protective factor [OR:0.907,95%CI:0.826-0.996, P=0.042]Conclusions:Broad-spectrum antibiotic plus metronidazole may not prevent the deterioration of NEC in full-term and near-term infants. Those infants who occurred sepsis and required transfusion of blood products supports after stage Ⅱ NEC were more likely to progress to stage Ⅲ.