Analysis Of Risk Factors Associated With Severity And Surgery In Neonatal Necrotizing Enterocolitis

Background and objective:Neonatal necrotizing enterocolitis(NEC)is a common digestive system emergency in neonates,especially preterm infants.The pathogenesis is complex and diverse,and the cause is unknown.Database statistics show that the incidence of neonatal NEC is about 0.1%-0.3%,the mortality is about 1/7,and about 20-40%of children with NEC need surgery.NEC mortality is as high as 50%in patients requiring surgery.10%to 30%of survivors often have severe complications:impaired nerve development,impaired vision and hearing,abnormal growth,difficulty feeding,diarrhea,intestinal obstruction,and short bowel syndrome.Early diagnosis and timely intervention are currently one of the important strategies to prevent the progression of the disease and improve the prognosis of NEC.This study analyzed the severity of NEC and related risk factors for surgery,and strived to provide a possible basis for the prediction of early surgery.Method:Forty-two patients with complete NEC admitted to Nanfang Hospital of Southern Medical University from August 2012 to May 2017 were enrolled in this study.The patients with congenital malformation,severe underlying diseases and no life support were admitted That is,dying or neonatal death within a few hours.According to surgery or not divided into surgical group and non-surgical group.According to the outcome,the patients were divided into improvement group and death abandonment group.Among them,the death abandonment group included the abandonment of treatment of critically ill children who died after discharge.To collect data for analysis,the application of SPSS 19.0 statistics.If non-normal distribution of measurement data,the comparison between groups using non-parametric test(Mann-Whitney)and the count data were compared between groups using the Fisher’s test or Fisher exact test.Result:1.There were 7 cases of neutropenia in the surgical group(77.8%)and 2 cases in the non-surgery group(22.2%).There was a statistically significant difference in neutropenia between the two groups(P=0.009).In the surgical group,there were 15 cases with elevated PCT,accounting for 71.4%,and 6 cases with non-surgical group,accounting for 28.6%.There was a statistically significant difference in the increase of PCT between the two groups(P<0.05).In the surgical group,there were 16 cases with elevated CRP,accounting for 84.2%,and 3 cases with non-surgical group,accounting for 15.8%.There was a statistically significant difference in the increase of CRP between the two groups(P<0.05).There was no statistically significant difference in blood culture positive,acidosis,thrombocytopenia,hypotension,hyponatremia,and surgery.The frequency of multiple indicators of multiple risk factors in the surgical group was greater than or equal to 3 in 9 cases(56.2%),and the frequency of comprehensive indicators in the non-surgical group was greater than or equal to 3 in 2 cases(7.7%),both in the surgical and non-surgical groups.A statistically significant difference in the frequency of multiple risk factors for multiple indicators(>=3)was found(P=0.001).2.There were 5 cases of acidosis in the death abandonment group,accounting for 71.4%,and 2 cases in the cured group,accounting for 28.6%.There was a statistically significant difference in acidosis between the two groups(P=0.001).There were 5 cases of thrombocytopenia in the death-giving group,accounting for 55.6%,and 4 cases of improvement in the cured group,accounting for 44.4%.There was a statistically significant difference in the thrombocytopenia between the two groups(P=0.012).There were 6 cases of hypotension in the death-giving group(85.7%),1 case of improvement in the cured group(14.3%),and there were statistical differences(P=0.000).There were 8 cases of elevated PCT in the death-waiving group,accounting for 36.3%,and 14 cases of improvement in the cured group,accounting for 63.7%.There was a statistically significant difference in the increase in PCT between the two groups(P=0.045).In the death-giving group,there were 8 cases with CRP elevation,accounting for 42.1%,and 11 cases with improvement in the cured group,accounting for 57.9%.There was a statistically significant difference in CRP elevation between the two groups(P<0.011).Blood culture positive,neutropenia,hyponatremia and death are statistically significant in five.3.Abdominal wall thickening accounted for 5.5%in the abdominal B-surgery group and 44.4%in the abdominal cavity.In the non-surgical group,the wall thickening accounted for 25%,and the effusion accounted for 29.2%.There was no significant difference in abdominal B-scan signs such as thickening of the intestinal wall and peritoneal effusion between the surgical group and the non-surgical group(P=0.094,P=0.307).4.Pneumoperitoneum is the only clear indication for NEC surgery.X-rays can be seen under the armpit free gas.Bloating gas appears in almost every child with NEC.Conclusion:1.The neutropenia,elevated PCT,and elevated CRP are high in children who need surgery and have a certain correlation with surgery,and when there are 3 or more NEC children with metabolic or inflammatory markers,Need to consider surgical treatment;2.Acidosis,thrombocytopenia,hypotension,elevated PCT/CRP is associated with the prognosis of children with NEC,when 3 or more metabolic indicators or inflammation indicators are abnormal,it can prompt severe NEC children’s condition Degree;3.Pneumoperitoneum as an absolute indication for surgery in children with NEC,but most of the time difficult to capture;4.Abdominal ultrasound can provide a simple and non-invasive method to monitor the progression of NEC at any time,but the relevance of surgery needs further the study.