| Necrotizing enterocolitis (NEC) is a fatal disease of the newborns and is the commonest gastrointestinal emergency in the neonatal intensive care unit (NICU). Because of it’s quick onset, high mortality, severe outcome and no special managements up to now, it’s necessary to analyze the risk or pretective factors of NEC in newborns and provide a therapeutic basis of its prevention and management. Purpose To analyze the risk or pretective factors of NEC in newborns. Methods The clinical data of125infants with NEC (named observative group) and189infants without NEC (named control group) in three NICUs(including Xiaolan Hospital of Southern Medical University, First Affiliated Hospital of Xiamen University and Nanjing Children’s Hospital of Nanjing Medical University) during January,2008and December,2012were collected using a questionnaire, and the following28items were analyzed using single factor analysis and multiple factors analysis:(1) the maternal obstetric factors such as maternal infections during pregnancy, premature rupture of membranes(PROM), hypertensive disease of pregnancy(HDP), types of pregnancy, antenatal glucocorticoid and delivery modes;(2) the production situations such as asphyxia;(3)the general conditions of the newborns such as sex, gestational age(GA), birth weight(BW), acidosis, hypoxia, hypercarbia and feedings;(4) the disease conditions of the infants such as respiratory respiratory disease(RDS), pneumonia, respiratory failure, oxygen inhalation, assisted ventilation, sepsis, septic shock, disseminated intravascular coagulation (DIC), anemia, hyperbilirubinemia, hyponatremia, hypokalemia and hypocalcaemia; and (5) the use of probiotics such as clostridium butyricum powder, live combined bacillus subtills and enterococcus faecium granules with multivitamins and live combined bifidobacterium, lactobacillus and streptococcus thermophilus tablets, etc. Single factor analysis and multiple factors analysis were performed to analyze the protective or risk factors of NEC in newborns using SAS statistical package, and analysis was performed further for the preterm or the term infants respectively. Results1. Analysis of the risk or pretective factors of NEC in newborns.(1) Data There were125newborns in the observative group, and the data were as follows:male84cases, female41cases; preterm infants76cases, term infants49cases, the average GA (34.9±3.7)w; low BW80cases, normal BW44cases, large BW one case, the average BW (2259.6±795.1)g; natural pregnancy115cases, artificial insemination10cases; vaginal delivery57cases, C-sect68cases; PROM29cases; maternal infections during pregnancy4cases; HDP17cases; antenatal glucocorticoids11cases;77cases with blood gas analysis after admission, acidosis33cases, hypoxia12cases, hypercarbia10cases;114cases with Apgar score recorded, asphyxia21cases; RDS14cases; pneumonia75cases; respiratory failure9cases; oxygen inhalation53cases, assisted ventilation26cases; feeding before the onset of NEC95cases; hyperbilirubinemia26cases; anemia26cases; sepsis56cases; septic shock10cases; DIC12cases; hyponatremia8cases; hypokalemia9cases; hypocalcaemia22cases; probiotics12cases. There were189newborns in the control group, and the data were as follows:male107cases, female82cases; preterm infants129cases, term infants60cases, the average GA (35.4±2.9)w; low BW107cases, normal BW79cases, large BW3cases, the average BW (2443.8±714.3); natural pregnancy183cases, artificial insemination6cases; vaginal delivery81cases, C-sect108cases; PROM42cases; maternal infections during pregnancy13cases; HDP27cases; antenatal glucocorticoids34cases;159cases with blood gas analysis after admission, acidosis83cases, hypoxia21cases, hypercarbia23cases; all cases with Apgar score recorded, asphyxia19cases; RDS17cases; pneumonia43cases; respiratory failure4cases; oxygen inhalation50cases, assisted ventilation26cases; feeding186cases; hyperbilirubinemia111cases; anemia44cases; sepsis11cases; septic shock0case; DIC0case; hyponatremia3cases; hypokalemia17cases; hypocalcaemia11cases; probiotics107cases.(2) Single analysis revealed that there was a significant difference between the observative group and the control group in birth weight, antenatal glucocorticoid, pneumonia, respiratory failure, oxygen inhalation, feeding before the onset of NEC, hyperbilirubinemia, sepsis, septic shock, DIC, hyponatremia, hypocalcaemia and probiotics.(3) Logistical regression analysis revealed that antenatal glucocorticoid (RR=0.298,95%CI0.092-0.973, P<0.05), hyperbilirubinemia (RR=0.416,95%CI0.208-0.832, P<0.05) and probiotics (RR=0.094,95%CI0.040-0.220, P<0.01) were the protective factors of NEC in newborns, whereas pneumonia (RR=3.910,95%CI1.963-7.790, P<0.01) and sepsis (RR=13.469,95%CI5.578-32.523, P<0.01) were the risk factors of NEC in newborns. Feeding (RR=0.045,95%CI0.010-0.197, P<0.01) was related to disease conditions of the newborns.2. Analysis of the risk or pretective factors of NEC in preterm infants. There were76preterm infants (60.8%) in the observative group, whereas there were129infants (68.3%)in the control group.(1) Data There were76newborns in the observative group, and the data were as follows:male51cases, female25cases; GA<28w3cases,28w-<34w41cases,34w-<37w32cases; average GA (32.5±2.6)w; BW<1000g4cases,1000g-<1500g18cases,1500g-<2500g50cases,2500g-<4000g4cases, average BW (1763.1±480.2)g; natural pregnancy68cases, artificial insemination8cases; vaginal delivery39cases, C-sect37cases; PROM21cases; maternal infections during pregnancy3cases; HDP13cases; antenatal glucocorticoids11cases;49cases with blood gas analysis after admission, acidosis27cases, hypoxia7cases,hypercarbia9cases;69cases with Apgar score recorded, asphyxia14cases; RDS13cases; pneumonia52cases; respiratory failure8cases; oxygen inhalation40cases, assisted ventilation19cases; feeding before the onset of NEC50cases; hyperbilirubinemia16cases; anemia23cases; sepsis30cases; septic shock7cases; DIC11cases; hyponatremia8cases; hypokalemia7cases; hypocalcaemia17cases; probiotics5cases. There were129preterm infants in the control group, and the data were as follows:male75cases, female54cases; GA<28w2cases,28w-<34w30 cases,34w-<37w97cases; average GA (33.9±2.0)w; BW<1000g3cases,1000g-<1500g7cases,1500g-<2500g87cases,2500g-<4000g31cases,≥4000g one case, average BW (2145.5±541.0)g; natural pregnancy125cases, artificial insemination4cases; vaginal delivery59cases, C-sect70cases; PROM37cases; maternal infections during pregnancy8cases; HDP18cases; antenatal glucocorticoids32cases;118cases with blood gas analysis after admission, acidosis65cases, hypoxia13cases, hypercarbia22cases;129cases with Apgar score recorded, asphyxia8cases; RDS17cases; pneumonia22cases; respiratory failure4cases oxygen inhalation37cases, assisted ventilation21cases; feeding128cases; hyperbilirubinemia84cases; anemia35cases; sepsis11cases; septic shock0cases; DIC0cases; hyponatremia3cases; hypokalemia16cases; hypocalcaemia10cases; probiotics72cases.(2) Single analysis revealed that there was a significant difference between the observative group and the control group in gestational age, birth weight, asphyxia, pneumonia, oxygen inhalation, feeding before the onset of NEC, hyperbilirubinemia, sepsis, septic shock, DIC, hyponatremia, hypocalcaemia and probiotics.(3) Logistical regression analysis revealed hyperbilirubinemia (RR=0.229,95%CI0.087-0.600, P<0.01) and probiotics (RR=0.045,95%CI0.011-0.182, P<0.01) were the protective factors of NEC in preterm infants, whereas pneumonia (RR=5.903,95%CI2.217-15.719, P<0.01) and sepsis (RR=5.026,95%CI1.617-15.624) were the risk factor of NEC in preterm infants. Feeding (RR=0.010,95%CI0.001-0.145,P<0.01) was related to diseases of the preterm infants.3. Analysis of the risk or pretective factors of NEC in term infants. There were49term infants (39.2%) in the observative group, whereas there were60term infants (31.7%) in the control group.(1) Data There were49term infants in the observative group, and the data were as follows:male33cases, female16cases; the average GA (38.6±1.3)w; low BW8cases, normal BW40cases, large BW one case, the average BW (3029.8±526.1)g; natural pregnancy47cases, artificial insemination2cases; vaginal delivery18cases, C-sect31cases; PROM8cases; maternal infections during pregnancy one case; HDP4cases; antenatal glucocorticoids0case;28cases with blood gas analysis after admission, acidosis6cases, hypoxia5cases, hypercarbia one case;45cases with Apgar score recorded, asphyxia7cases; RDS one case; pneumonia23cases; respiratory failure one case; oxygen inhalation13cases, assisted ventilation7cases; feeding before the onset of NEC45cases; hyperbilirubinemia10cases; anemia3cases; sepsis26cases; septic shock3cases; DIC one case; hyponatremia0case; hypokalemia2cases; hypocalcaemia5cases; probiotics7cases. There were60term infants in the control group, and the data were as follows:male32cases, female28cases; the average GA (38.6±1.1)w; low BW10cases, normal BW48cases, large BW2cases, the average BW (3085.2±615.0)g; natural pregnancy58cases, artificial insemination2cases; vaginal delivery22cases, C-sect38cases; PROM5cases; maternal infections during pregnancy5cases; HDP9cases; antenatal glucocorticoids2cases;41cases with blood gas analysis after admission, acidosis18cases, hypoxia8cases, hypercarbia one case; all cases with Apgar score recorded, asphyxia11cases; RDS0case; pneumonia21cases; respiratory failure0case; oxygen inhalation13cases, assisted ventilation5cases; feeding58cases; hyperbilirubinemia27cases; anemia9cases; sepsis0case; septic shock0case; DIC0case; hyponatremia0case; hypokalemia one case; hypocalcaemia one case; probiotics35cases.(2) Single analysis revealed that there was a significant difference between the observative group and the control group in hyperbilirubinemia, sepsis and probiotics.(3) Logistical regression analysis revealed probiotics (RR=0.221,95%CI0.071-0.690, P<0.01) was the protective factor of NEC in term infants. Conclusion Antenatal glucocorticoid, hyperbilirubinemia and probiotics are the protective factors of NEC in newborns, whereas pneumonia and sepsis are the risk factors of NEC in newborns. Hyperbilirubinemia and probiotics are the protective factors of NEC in preterm infants, whereas pneumonia and sepsis are the risk factors of NEC in preterm infants. Probiotics is the protective factor of NEC in term infants. Antenatal glucocorticoid and early use of probiotics could prevent the development of NEC in newborns. It’s necessary for the newborns/preterm infants with pneumonia and/or sepsis to be observed carefully to avoid the development of NEC. Excessive management may be not essential for newborns/preterm infants with hyperbilirubine- mia. The decreased likely hood of feeding prior to NEC is likely due to delayed initiation of enteral feeding in critically ill newborns. |
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