| Objective: To analyze the clinical data of necrotizing enterocolitis(NEC)in newborns of our hospital retrospectively and explore the early operative indications and clinical predictors of NEC,improving the prognosis of NEC.Methods: The clinical data of 146 patients with NEC diagnosed by Neonatal Department and Pediatric Surgery Department from January 2010 to December 2017 in Affiliated Hospital of Zunyi Medical College were analyzed retrospectively.They were divided into two groups: surgical and non-surgical treatment.Recording the details of the two groups: the maternal perinatal status,the general condition of the children,clinical manifestations,complications,laboratory inspections and radiographic findings.Univariate analysis of the above indicators were used firstly,if the statistical difference was significant,it would be performed by multivariate logistic regression analysis,meanwhile,combining with ROC curve and Youden index to assess and screen out the early operative indications and predictors of NEC.Results: Univariate analysis results: birth weight,gestational age,abdominal erythema,disappearance of the bowel sounds,poor response,fever,peritonitis,septic shock,metabolic acidosis,neonatal acute respiratory distress syndrome and asphyxia,comparing all the indicators above between the two groups,the differences were statistically significant(P <0.05).As to maternal perinatal status,sex,feeding method,age at onset,abdominal distension,bloody stool,vomiting,gastric retention,apnea,neonatal pneumonia,neonatal hyperbilirubinemia,sepsis,electrolyte imbalance and respiratory failure,there was no significant difference between the two groups(P>0.05).However,prealbumin,interleukin-6,procalcitonin,C-reactive protein,white blood cells,pneumoperitoneum,intestinal wall pneumatosis and portal venous gas sign,the differences of above between the two groups were statistically significant(P<0.05).Besides,there was no significant difference about platelet count,intestinal dilatation,intestinal obstruction and intestinal effusion(P>0.05).Multivariate logistic regression analysis results: peritonitis(OR=95.635,95%CI:25.312~361.339),interleukin-6(OR=1.001,95%CI:1.000~1.001)and portal venous gas sign(OR=22.551,95%CI:1.802~282.190)all were independent factors of early NEC surgery(P<0.05).ROC curve analysis results: interleukin-6 and procalcitonin both had good predictive efficacy,whose area under the curve of were 0.875 and 0.798,respectively.Youden index: the best cut-off value for interleukin-6 was 476 pg/m L,with a sensitivity of 80.4%,a specificity of 85.6% and a positive predictive value of 77.6%.The optimal cut-off value of procalcitonin was 1.53 ng/m L,the sensitivity was 83.9%,the specificity was 70% and the positive predictive value was 63.5%.Conclusions:(1)NEC children who were manifested with poor response,fever,abdominal erythema,disappearance of the bowel sounds and associated with peritonitis,septic shock,metabolic acidosis and portal venous gas sign in abdominal X-ray findings had early surgical indications.Peritonitis and portal venous gas sign were the independent factors in early NEC surgical treatment among them.(2)The serum levels of interleukin-6 was higher than 476pg/ml or procalcitonin was greater than 1.53ng/ml in children with NEC marked that there was an indication for early operation.Especially,interleukin-6 was an independent factor in predicting the surgical opportunity of NEC. |
