Epidemiological Study And The Plasma Glutamine Concentrations In Infants With Necrotizing Enterocolitis

Object: To investigate the risk factors for necrotizing enterocolitis (NEC), and determine the relationship between the plasma levels of glutamine(Gln) and NEC. Methods: A case-control study was conducted to identify risk foctors for NEC from January 1997 to May 2003 in the department of Neonatology , Fujian Maternity and Children Health Care Hospital. Eighty-one infants were diagnosed as cases of NEC. And we chose 162 non-NEC infants who were the same sex and age as the controls. The univariate (2 analysis and conditional multiple regression were performed to identify the risk fators for NEC. Sixteen infants were develop NEC from October 2002 to October 2003. And we also chose sixteen non-NEC infants as the controls, who were the same sex, age, correspond gestational age and birth weight. We measured the plasma levels of Gln of these infants and control ones by RP-HPLC, and observed the change of the plasma levels of Gln. Then we determine the relationship between the plasma levels of Gln and NEC after controlling the possible confounding bias by multivariate analysis. Results: In the clinical epidemiological study, we found out that the incidence of NEC was increased year by year. The mean gestational age was 33.31±2.89 weeks, and mean birth weight was 1.749±0.756kg. Most infants who developed NEC had received enteral feedings and had other diseases at the same time. Multiple risk factors, such as: parturition number, twin birth,preterm,birth weight,sepsis,pneumonia,anemia,received indomethacin,thrombocytopenic,perinatal stress and/or asphyxia, were present in these infants, were significant different among NEC and control group infants(P<0.05). Conditional logistic regression analysis still showed that variables : twin birth,preterm,birth weight,sepsis,pneumonia,perinatal stress and/or asphyxia were the risk fators for NEC. The clinical experiment study showed the mean plasmalevel of Gln in NEC was 0.2108±0.0813mmol/L, which was significantly lower than controls (0.3490±0.1388 mmol/L)(P<0.05). Adjusted mean plasma levels and 95% confidence interval of Gln in NEC and control group were 0.216 mmol/L(0.150～0.282mmol/L),0.344 mmol/L(0.278～0.410mmol/L), respectively. There was significant difference between two groups(P=0.032). The univariate (2 analysis showed that variables: plasma level of Gln, hypoxia and infection were significant difference between two groups. And the variables: plasma level of Gln and hypoxia were the risk factors for NEC in conditional multiple regression.Conclusion: NEC is the common alimentary tract disease in neonates, and the incidence of NEC was increased year by year. The risk factors for NEC are: preterm,low birth weight, ischemia diseases in perinatal period,hypertonic formula and drugs,infection. Infants who developed NEC have reduced level of Gln, and reduced level of Gln may predispose to the illness.