The Clinical Research On The Evaluation Of The Severity Of Neonatal Necrotizing Enterocolitis

Objective: The purpose of this retrospective research is searching reliable clinical predictors of severe disease,evaluating the treatment and prognosis, guiding clinical treatment by analyzing the relative clinical data.Methods: This is a retrospective review of data collected from the medical records of newborns with confirmed NEC, treated at the Shenzhen Children’s Hospital from January 2008 to December 2014.The medical records include general situation of infants, the related factors of NEC occurrence, clinical features, laboratory, radiographic, treatment and prognosis. 240 cases were divided into two groups according to Bell stage, mild group(stageⅠ+Ⅱa,155 cases), severe group(stageⅡb+Ⅲ85cases). Single factor analysis and multifactor logistic regression analysis was carried out for the two groups of children. And evaluate by ROC curve and Youden index.Results: This study analyzed high risk factors of severe NEC in two groups of children, Univariate analysis revealed that the rate of gestational age < 32 weeks, birth weight <1500 g, artificial feeding,history of asphyxia, sepsis in severe group is higher than mild group(P<0.05).And history of asphyxia(OR=3.496,CI:1.082~11.291), sepsis(OR=4.226,CI:1.759~10.156) are major risk factors associated with the severity of the disease. In severe group WBC<5*1012/L, PLT<150*109/L, CRP>20mg/dl, metabolic acidosis, abdominal distention, abdominal vein and abdominal wall redness, muscle tension were obviously higher than that of the incidence of mild group,(P < 0.05). The evaluation of ROC curve and Youden index score showed that AUC of CRP, DAAS scores are respectively 0.811, 0.909. CRP and DAAS scores had a good prediction effect t. In the mild group, the rate of surgical treatment and mortality were 0 and the incidence of intestinal stenosis was 1.3%(2/155). In the severe group the operation rate was 61.2%(52/155), the mortality rate was 20%(17/85), the incidence of intestinal stenosis was 12.9%(11/85), and the incidence rate of short bowel syndrome was 1.2%(1/85).Conclusions:(1)GA(gestational age)<32w,BW(birth eight)<1500g, artificial feeding, sepsis and asphyxia were major risk factors associated with the severity of the disease.(2)Abdominal distention, abdominal vein and abdominal wall redness, muscle tension were the main clinical features of severe NEC.(3)WBC<5×1012/L, PLT<150×109/L, assistant CRP >20mg/dl, metabolic acidosis and imaging DAAS scores were the main indexes to reflect the severity of NEC.(4)The mortality rate of severe NEC was 20%, and intestinal stenosis was the main complication in children with severe NEC.