| Objective:To retrospectively analyze the medical records of 365 cases of neonatal necrotizing enterocolitis(NEC)clearly diagnosed in our hospital,and to summarize the risk factors of NEC and the clinical manifestations of NEC in term and preterm infants.Comprehensive treatment measures and prevention of NEC provide theoretical basis.Methods:We collected neonates with a clear diagnosis of NEC in the neonatal department of our hospital from October 2014 to September 2019,and the medical records of pregnant mothers and children were complete and authentic.Statistics and analysis were performed.The statistics include: Situation: Gender,gestational age,birth weight,presence of concurrent PDA,age at onset,history of asphyxia,feeding ingredients,prophylactic antibiotics,diagnosis of sepsis,history of blood transfusion 48 hours before onset;: Hypertension during pregnancy(including hypertension with pregnancy,hypertension during pregnancy),gestational diabetes(including diabetes with pregnancy,hyperglycemia during pregnancy),history of premature rupture of membranes,placental factors(placental abruption,preposition Placenta,placental fragmentation,etc.);(3)clinical manifestations: abdominal distension,reduced bowel sounds,vomiting,feeding intolerance,acute abdomen,bloody stool,systemic symptoms,etc.;(4)laboratory indicators: white blood cells,platelets,CRP and blood culture;(5)Features of abdominal color Doppler ultrasound: including weakened intestinal peristalsis,hepatic gas accumulation,intestinal wall gas accumulation,intestinal wall thickening,intestinal dilatation and intestinal perforation;(6)treatment methods and prognosis: treatment method Divided into medical treatment and surgical therapy;prognosis include: cured,healed and death.According to the gestational age,they were divided into premature infant group and full-term infant group,and were divided into two groups according to clinical diagnosis and staging: one group was stage Ⅰ,and the other group was stage Ⅱ + Ⅲ.At the same time,the total number of patients discharged from the neonatal department of our hospital during the same period was counted to calculate the incidence of NEC.SPSS 23.0 statistical software package was used to analyze and plot the statistical data.The birth weight,onset time,and onset gestational age were expressed as mean ± standard deviation(`X ± s).The influencing factors of NEC were first analyzed by a single factor.Then,multiple factor logistic regression analysis was performed on multiple related factors,P <0.05 was statistically different.Results:1.The incidence of neonatal NEC in our hospital was 1.7%(62/3728)in 2015,1.6%(72/4505)in 2016,1.5%(72/4650)in 2017,and 1.4%(70/4864)in 2018.2.A total of 365 children with NEC were collected in this study,including 207 males(56.7%),158 females(43.3%),281 premature infants(77%),and 84 full-term infants(23%).The premature infant group had a birth weight of 1.72 ± 0.53 kg,an age of onset of 14.86 ± 7.58 days,and an onset of gestational age of 32 ± 2.76 weeks;a fullterm infant group had a birth weight of 3.10 ± 0.56 kg,an onset of age of 8.19 ± 6.04 days,and an affected fetus The age was 38.75 ± 1.22 weeks.In the premature infant group,219 cases(77.9%)were medically treated,62 cases(22.1%)were treated by surgery,265 cases(94.3%)were cured,5 cases(1.8%)were unhealed,and 11 cases(3.9%)died;term In the pediatric group,66 patients(78.6%)were medically treated,18 patients(21.4%)were surgically treated,78 patients(92.9%)were cured,1 patient was discharged(1.2%),and 5 patients(6%)died.3.According to the NEC stage,77 cases(21.1%)of stage Ⅰ NEC included 55 cases(71.4%)of preterm infants,22 cases(28.6%)of term infants,and 288(78.9%)of stage II + III NEC,of which 226 were preterm infants.(78.5%),62 full-term infants(21.5%).There was no statistical difference between the preterm infant group and the term infant group in the stage I,Ⅱ + Ⅲ.4.NEC clinical manifestations: 223 cases of abdominal distension(61.1%),54 cases of vomiting(14.8%),161 cases of bloody stool(44.1%),systemic symptoms(fever,skin graying,poor response,blood oxygen fluctuations,etc.)151 cases(41.4%)Intestinal sounds were reduced in 255 cases(69.9%),acute abdomen in 109 cases(29.9%),and feeding intolerance in 145 cases(39.7%).There were 168 cases of abdominal distension in premature infants(59.8%),40 cases of vomiting(14.2%),107 cases of bloody stools(38.1%),127 cases of systemic symptoms(45.2%),194 cases of bowel sound reduction(69.0%),and acute abdomen.67 cases(23.8%)of the disease,124 cases of feeding intolerance(44.1%);55 cases of abdominal distension(65.5%),14 cases of vomiting(16.7%),54 cases of blood stool(64.3%),systemic symptoms 24 There were 61 cases(72.6%)with reduced bowel sounds,42 cases(50%)with acute abdomen,and 21 cases(25%)with feeding intolerance.Comparison of preterm infant group and term infant group: systemic symptoms,bloody stool,acute abdomen,feeding intolerance were statistically significant(P <0.05),but abdominal distension,vomiting,and bowel sounds were not statistically different.Among them,bloody stool and acute abdomen are the prominent manifestations of term infants,while systemic symptoms and feeding intolerance are the main manifestations of preterm infants.5.In the analysis of risk factors related to prevalence,the preterm infant group was compared with the term infant group: premature rupture of membranes,history of asphyxia,prophylactic antibiotics,and PDA were significantly different between the two groups(p <0.05);while gender and pregnancy existed There were no statistically significant differences between the two groups,including hypertension,hyperglycemia during pregnancy,feeding patterns,placental factors,history of blood transfusion 48 hours before onset,and septicemia before onset.Phase I group compared with phase Ⅱ + Ⅲ group in premature rupture of membranes,history of asphyxia,prophylactic antibiotics,PDA,hypertension during pregnancy,hyperglycemia during pregnancy,feeding pattern,placental factors,and history of blood transfusion 48 hours before onset There was no statistical difference(all P> 0.05).6.In laboratory tests,compared with term infants and preterm infants,there was a significant difference in CRP elevation and blood culture positive rate(p <0.05).There was no significant difference in white blood cell count and thrombocytopenia.Comparison between the two groups of stage Ⅰ and stage Ⅱ + Ⅲ: there was a statistically significant difference in thrombocytopenia and CRP increase(P <0.05),and there was no statistical difference in white blood cell count and positive rate of blood culture.7.The frequency of abdominal color Doppler ultrasonography in children with NEC from high to low was 224 cases(61.4%)of intestinal peristalsis,159 cases(43.6%)of hilar gas,129 cases(35.3%)of gas in the intestinal wall,and increased intestinal wall.125 cases(34.2%)were thick,63 cases(17.3%)had intestinal dilatation,and 17 cases(4.7%)had intestinal perforation.8.Therapeutic methods and prognosis: 285 cases(78.1%)of medical treatment,80 cases(21.9%)of surgical treatment;343 cases(94.0%)were cured,6 cases(1.6%)were unhealed,and 16 cases(4.4%)died..There were no statistical differences in treatment and prognosis between the preterm infant group and the term infant group.Conclusion:1.The incidence of NEC in the neonatal department of our hospital decreased slowly from 2015 to 2018.2.The prevalence of NEC is predominant in infants,with no significant difference in gender.3.Premature rupture of membranes,history of asphyxia,and preventive antibiotics are independent risk factors for NEC in preterm infants.4.The incidence of NEC in formula feeding is significantly higher than breastfeeding and mixed feeding.5.The clinical manifestations of NEC are not specific.Both premature and term infants can show abdominal distension,vomiting,bloody stools,weak bowel sounds,acute abdomen,and systemic symptoms.Full-term infants are characterized by bloody stools and acute abdomen,while premature infants are characterized by systemic symptoms and feeding intolerance.6.Thrombocytopenia and CRP increase can be used as one of the reference indicators for the diagnosis of severe NEC children.7.The incidence of CRP elevation in term infants with NEC was significantly higher than that in preterm infants,and the positive rate of NEC blood culture was significantly higher in term infants than in term infants.8.The characteristic abdominal color Doppler ultrasound manifestations of children with NEC,such as thickening of the intestinal wall,gas accumulation in the intestinal wall,and hepatic hilum,can provide reliable imaging basis for early clinical diagnosis and monitoring of NEC.According to the progress of children’s clinical manifestations,combined with the dynamic monitoring of abdominal color Doppler ultrasound,it can be used as a non-invasive indicator of surgical treatment. |
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