| Neonatal necrotizing enterocolitis (NEC) is the most serious acutegastrointestinal tract disease during the neonatal period. It threatens the healthand life of the neonates, especially premature and low birth weight babies. Itis believed that NEC results in premature, low birth weight, improper feeding,infection, hypoxia and ischemia, but it has not been clear yet. The prognosisof mild NEC is just good, but the prognosis of severe cases which havedifficult treatment and high mortality are quiet poor. So it is very importantfor us to make the risk factors of NEC clearly in order to diagnose and treatthe disease early, and to find an effective way in preventing NEC. This paperaims to discuss the risk factors of NEC, and to provide the basis for itsprevention and treatment. We selected128neonates who were diagnosed byNEC and met the study criterias during January,2004to December,2012admitted to neonatal department of First Hospital of Jilin University. Clinicalinformation of these cases were reviewed and analyzed, including (1)characteristics of the disease: onset time and the stage of disease.(2) Maternalperinatal factors:①infection: premature rupture of membranes, amnioticfluid abnormality and prenatal infection.②abnormalities of placental andumbilical cord: placental abruption, placenta praevia, umbilical cord aroundthe neck and other abnormalities.③perinatal hypoxia histories: intrauterine distress and anoxia after birth.④high hypertension during pregnancy:pregnancy-induced hypertension and chronic hypertension.⑤the mode ofdelivery.⑥hormone usage history before delivery.（3） children’s factors:①whether a twin or not.②gestational age and birth weight.③meconium delay discharge: meconium delay for first time and the durationlong.（4）feeding history:①the onset time of feeding.②The types ofdairy products.③the largest amount of feeding and the speed of feedingincrease before onset of NEC.（5）accompanied disease: anemia, septicemia,intracranial hemorrhage, patent ductus arteriosus, respiratory distresssyndrome, hypoglycemia, hirschsprung disease and so on.（6）antibioticstherapy history: anti-infection therapy before onset of NEC and the period ofantibiotics.（7） prognosis:①complications: gastrointestinal perforationand peritonitis.②the final treatment outcome.Results: The neonatal necrotizing enterocolitis cases admitted in ourhospital have increased during2004to2012in general. Time of onset was1~28days (median6days),105cases (82.0%) had an NEC attack within14days. The median age of onset in premature NEC babies was10days, and20term babies arose NEC within3days which accounts for45.5%of termpatients. NEC Staging:31cases (24.2%) was in stageⅠ (suspected NEC),52cases (40.6%) was in stageⅡ (confirmed NEC) and45patients (35.2%) wasin stage Ⅲ (severe NEC). Maternal perinatal factors: Infection factors were involved in53cases (41.4%), abnormalities of placental and (or) umbilicalcord were involved in34cases (26.6%), perinatal hypoxia histories wereinvolved in32cases (25.0%),29mothers of patients (22.7%) had high bloodpressure during pregnancy, and17mothers of patients had usedcorticosteroids before delivery which accounts for20.2%of premature cases.Children’s factors: In this study,16NEC patients (12.5%) were the twin,2ofthem were twins, and the other14cases were not. There were84prematurebabies (65.6%) and44term infants (34.4%) among the128cases in our study.82cases (64.1%) were low birth weight infants whose birth weight were lessthan2500grams. The amount of patients with meconium delay discharge was84which accounts for75.7%of clear meconium history. Feeding history: Thefirst time of feeding were as follows:65cases (50.8%) were within24hoursafter birth,37cases (28.9%) were ranged from24to96hours, and12cases(9.4%) were later than4days after birth. Except14cases (10.9%) had notbegun feeding before NEC,94of114cases (82.5%) were fed with formula,and other13cases (11.4%) were fed with mixed milk that was blended bybreast milk and formula. The largest amount of feeding before onset of NECvaried from1.6to195mL/(Kg.d).25cases (21.9%) had a rapid increase [>20mL/(Kg.d)] in feeding. Other diseases which associated with NEC were seenin109cases (85.2%), anemia and septicemia were the most two commondiseases among these109patients, the former one in68cases（53.1%）, andthe latter one in51cases (39.8%). Most of the pathogens of these septicemias were Escherichia coli（28.1%） and Cray Borrelia bacteria（21.9%）. Inaddition to these two bacteria, staphylococcus, blastocystis, baumanii,enterococcus faecalis and pseudomonas aeruginosa were also seen insepticemias. Antibiotics were administrated prior to NEC in52cases (40.6%)with period of treatment for1~15days (median5days), and12of them hadused antibiotics for prevention.Conclusions:1. The neonatal necrotizing enterocolitis had a growing increase inneonatal department of our hospital in recent9years.2. NEC is related to premature, low birth weight, infection, improperfeeding, meconium delay, companied by severe ischemic and hypoxic diseaseand unreasonable antibiotics treatment, and it is usually the result of manyfactors.3. NEC can be seen in the whole neonatal period. The onset time of terminfants is earlier than premature ones, but term NEC patients who areaccompanied by hirschsprung disease attack NEC relatively late.4. There are no effective ways in curing the bad prognosis disease NECwhich has high mortality so far, so we should pay more attention to the riskfactors in order to prevent this disease effectively. |
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