Analysis Of High Risk Factors For Parenteral Complications And Death Of Necrotizing Enterocolitis In Premature Infants

Part I Analysis of high risk factors of necrotizing enterocolitis complicated with extrauterine growth retardation in premature infantsObjective:The clinical data of necrotizing enterocolitis in premature infants were retrospectively analyzed to explore the high risk factors of NEC complicated with extrauterine growth retardation in premature infants.Methods:A total of 101 premature NEC infants admitted to the Department of Neonatology,Affiliated Hospital of Qingdao University from January 2013 to February 2021 were selected as the research subjects.According to the combination of EUGR,they were divided into EUGR combination control group.χ~2analysis,continuous correctionχ~2analysis,independent sample t test,t’test,rank sum test and multivariate Logistic regression were used to analyze the risk factors of NEC complicated with EUGR in premature infants by reviewing the clinical data of NEC children.Results:1.A total of 6519 preterm infants were admitted to the Neonatal Intensive Care Unit of our hospital during the study period,101 of whom developed NEC,with an overall incidence of 1.55%.Among them,26 children received surgical treatment,with a rate of25.7%;19 children died or gave up treatment due to diseases,social factors,and the mortality rate was 18.8%.The mean gestational age at birth was 31 weeks+4 days,the mean birth weight was 1600g,and the mean age of onset was 17 days.81 cases(80.2%)had antibiotic use history before onset,the mean fasting time after onset of NEC was 11days,and the mean parenteral nutrition time after onset of NEC was 23 days.There were62 cases of EUGR,accounting for 61.4%,including 19 cases of EUGR combined with cholestasis,13 cases of EUGR combined with metabolic bone disease,4 cases of EUGR,metabolic bone disease,and cholestasis,26 cases of EUGR alone,and 39 cases of non-EUGR,accounting for 38.6%.2.Compared with the control group,the children in EUGR group had smaller gestational age(31W:32W+2d,P=0.008)and lower birth weight(1447.56g:1844.87g,P=0.005).The proportions of NRDS(80.6%:38.5%,P=0.000)and SGA(21.0%:7.7%,P=0.045)were significantly higher than those in the control group.The percentage of umbilical or central vein catheterization in EUGR group was higher than that in control group(31.1%:5.1%,P=0.000).The proportion of erythrocyte transfusion was higher in EUGR group before onset(32.3%:10.3%,P=0.011),and the proportions of PDA and sepsis in EUGR group were significantly higher than those in control group(27.4%:7.7%,71.0%:43.6%,P<0.05).3.The use of antibiotics before the onset of NEC in EGUGR group was longer than that in control group(8.81d:5.26d,P=0.005),and the use rate of caffeine was higher than that in control group(64.5%:30.8%,P=0.001).The rate of enterotomy was higher in EUGR group(22.6%:10.3%,P=0.026).4.Enteral and parenteral nutrition:the average fasting time and parenteral nutrition time of children in EUGR group were significantly longer than those in control group(12.48d:9.31d,25.94d:18.90d,P<0.05).Compared with the control group,the rates of breastfeeding and feeding intolerance in EUGR group were higher(40.3%:19.7%,64.5%:43.6%,P<0.05).5.Multivariate analysis showed that SGA(B=2.161,OR=8.682,95%CI[1.583,47.613],P=0.013,),PDA(B=1.632,OR=5.071,95%CI[1.153,22.296],P=0.032),blood transfusion(B=1.723,OR=5.601,95%CI[1.139,27.541],P=0.034),intestinal resection(B=2.316,OR=10.135,95%CI[2.172,47.302],P=0.003),parenteral nutrition time after onset(B=0.045,OR=1.046,95%CI[1.002,1.093],P=0.039)were independent risk factors for NEC children with EUGR.Conclusion:1.NEC children have a high incidence of EUGR.2.SGA,PDA,blood transfusion,intestinal resection,and parenteral nutrition time after onset were independent risk factors for NEC children with EUGR.PartⅡ Analyses the risk factors of necrotizing enterocolitis complicated with brain injury in premature infantsObjective:The clinical data of NEC infants were retrospectively analyzed to explore the high risk factors of NEC complicated with brain injury in premature infants.Methods:A total of 101 premature NEC infants admitted to the Department of Neonatology,Affiliated Hospital of Qingdao University from January 2013 to February 2021 were selected as the research subjects.They were divided into brain injury group and control group according to cranial magnetic resonance examination results at discharge.χ~2analysis,continuous correctionχ~2analysis,independent sample t test,t’test,rank sum test and multivariate Logistic regression were used to analyze the risk factors of NEC complicated with brain injury in preterm infants by comparing the clinical data of the brain injury group and the control group.Results:1.Of the 101 children included in the study,there were 18 cases of brain injury,accounting for 17.8%of the total,including 12 cases of cerebral hemorrhage,accounting for 66.7%of the children with brain injury,and 6 cases of cerebral white matter ischemia,accounting for 33.3%of the children with brain injury.2.There were no significant differences in gestational age,sex,birth weight,SGA and intrauterine distress in the NEC combined with brain injury group compared with the control group.Postnatal complications such as sepsis,PDA,NRDS,anemia,and blood transfusion were not significantly different between the two groups.The use of prenatal hormones,postnatal caffeine,antibiotics,and PS did not differ between the two groups.3.The incidence of shock(61.1%:28.9%,P=0.009),DIC(55.6%:24.1%,P=0.008),hyperglycemia(61.1%:34.9%,P=0.040)and respiratory failure(66.7%:39.8%,P=0.037)were higher in the brain injury group than in the control group.The proportion of children in the brain injury group requiring mechanical ventilation and surgical treatment at the onset of NEC was higher than that in the control group(55.6%:15.7%,55.6%:19.3%,P<0.05),and the proportion of children in the brain injury group having intestinal perforation before surgery was higher than that in the control group(33.0%:12.0%,P=0.036).4.Multivariate analysis showed that mechanical ventilation(B=1.557,OR=4.744,95%CI[1.476,15.251],P=0.009),surgery(B=1.235,OR=3.438,95%CI[1.075,10.999],P=0.037)was an independent risk factor for brain injury in NEC preterm infants.Conclusion:1.NEC children are prone to brain injury.2.Mechanical ventilation and surgery are independent risk factors for brain injury in NEC premature infants.PartⅢ Analyses the risk factors of necrotizing enterocolitis complicated with the death in premature infantsObjective:Clinical data of children with NEC were retrospectively analyzed to explore the risk factors of death in children with NEC.Methods:A total of 101 premature NEC infants admitted to the Department of Neonatology,Affiliated Hospital of Qingdao University from January 2013 to February 2021 were selected as the research subjects.According to the clinical outcomes of the children,they were divided into the death group and the survival group.Statistical methods such asχ~2analysis,continuous correctedχ~2analysis,independent sample t test,t’test,rank sum test,multivariate Logistic regression and ROC curve were used to review the clinical data of the children with NEC to explore the risk factors for the death of the children with NEC.Results:1.A total of 19 NEC children died or died after abandoning treatment,with a mortality rate of 18.8%.Severe NEC was the primary cause of death,accounting for 63%of the deaths.2.Death group combined with shock(73.7%:25.6%,P=0.000),DIC(57.9%:23.2%,P=0.003),preoperative intestinal perforation(36.8%:11.0%,P=0.011),severe NEC(63.2%:29.3%,P=0.005)was higher than that in the survival group.The ratio of CRP to serum albumin in the death group was higher than that in the survival group(0.756:0.458,P=0.034),the platelet in the death group was lower than that in the survival group(110.05:156.61,P=0.011),and the surgical treatment in the death group(63.2%:17.1%,P=0.000)and mechanical ventilation(63.2%:13.4%,P=0.000)were higher than those in survival group.3.Multivariate analysis showed that surgical treatment(B=1.705,OR=5.495,95%CI[1.658,18.182],P=0.013),mechanical ventilation(B=2.138,OR=6.061,95%CI[1.897,21.276],P=0.003),elevated CAR(B=2.039,OR=7.692,95%CI[2.304,25.640],P=0.001)were independent risk factors for death in NEC children.Elevated CAR was the most significant risk factor for death(OR=7.692).4.The ROC curve indicated that CAR was of significant significance in predicting the mortality of NEC children.The area under the curve(AUC)is 0.773.The cut-off value(AUC)is 0.647.The specificity is 0.780.The sensitivity is 0.789.Conclusion:1.Surgical treatment,mechanical ventilation,and elevated CAR ratio are independent risk factors for poor prognosis in children with NEC.2.CAR ratio can be used to predict NEC prognosis.