Clinical Analysis Of Neonatal Necrotizing Enterocolitis With Hirschsprung's Disease

Research BackgroundNeonatal necrotizing enterocolitis(NEC)is one of the most common acute gastrointestinal tract diseases during the neonatl period.Clinical Findings:The major symptoms were feeding intolerance,emesis,bloody stool,abdominal tenderness and shock,With the development of perinatal medicine,the number of premature infants and low birth weight infants increased,and the number of necrotizing enterocolitis of newborn increased.However,this disease progresses vary fast,especially in severe cases,often associated with perntonitis and intestinal perforation,requiring surgical intervention.However,its indications for advanced surgery are difficult to grasp,and it is easy to miss the opportunity for surgical intervention,resulting in poor prognosis.At present,NEC has become an important cause of death for newborns,especially premature infants.However,the etiology and pathogenesis of NEC are still unclear.At present,scholars believe that NEC is a complex disease caused by multiple factors,which is related to various factors such as immature intestinal development,incomplete establishment of intestinal flora,circulation disorder and improper feeding[1].Studies have shown that congenital alimentary tract malformation is an important cause of NEC in full-term infants.Hirschsprung's Disease(HD),also known as congenital angangliocytosis,is a developmental disorder of the intestinal nervous system in the embryonic stage,resulting in the absence of ganglion representation in the submucosa of the distal intestinal canal and the muscle layer.Its etiology is complex,and it is generally considered to be a combination of environmental factors and genes.HD is one of the most common congenital alimentary tract malforma1aonm in pediatric surgery[2],ranking the second in pediatric alimentary tract malformation,Avitih a incidence of 1:2,000-1:5,000.Male children are slightly higher than female children and have certain:genetic susceptibility.The typical clinical manifestation of HD is refractory constipation with delayed defecation.and exhausting time.In the neonatal period,it was mainly manifested as low intestinal obstruction,.abdominal distension,emesis,and dificulty of fecal excretion.At present,rare cases of NEC combined with HD have been reported domestic and overseas,while cases of NEC children combined with HD are not uncommon in clinical work.Chapter 1 Clinical analysis of 23 cases of neonatal necrotizing enterocolitis with Hirschsprung's DiseaseResearch ObjectiveTo investigate the clinical features of patients in neonatal necrotizing enterocolitis(NEC)complicated with Hirschsprung's disease(HD).Materials and methods1 Case selectionHospitalized patients with NEC and HD treated in Zhongshan Boai hospital of southern medical university from Jan 2010 to Dec 2017 were enrolled retrospectively.Conform to"Practice of neonatology(the fourth edition)" diagnostic criteria of neonatal necrotizing enterocolitis,289 cases of neonatal NEC continuous abnormal of rectal biopsy(based site,located 2.5 cm above the dentate line),pathological prompt rectal muscular layer did not found the ganglion cells,the diagnosis of NEC consolidated HD a total of 23 cases.All the studies were not only approved by family members,but also approved by the medical ethics committee of the hospital.2 Methods2.1 clinical data collection:the gestational age,birth weight,feeding method,gender,onset age,clinical manifestations,laboratory test results and abdominal X-ray manifestations of NEC patients with HD were collected.2.2 clinical staging:patients were graded according to the Bell staging standard.2.3 treatment measures:1)conservative treatment:abrosia,gastrointestinal decompression,anti-infection,intravenous nutrition,maintaining internal environment stability,etc.2)surgical treatment:intestinal perforation and complete intestinal obstruction are the indications of NEC surgery,and abdominal mass,ascites,abdominal fixation of bowel loop,etc..3 Statistical processingSPSS 19.0 software was used for statistical analysis.The measurement data of normal distribution were expressed as mean plus or minus standard deviation,while the measurement data of non-normal distribution were expressed as median and quartile spacing.U test was used for comparison of rates between the two groups,and p<0.05 was considered statistically significant.Research results1 Prevalence of NEC with HDFrom January 2010 to December 2017,of the 289 consecutive neonatal NEC cases diagnosed in zhongshan boai hospital of southern medical university,23 cases were combined with HD,accounting for 7.95%of the total hospitalization of NEC during the same period,which was significantly higher than the incidence of HD(U=60.15>1.96,p<0.05).2 General casesBell stage ? in 2 cases,? period 4 cases,17 cases ? period.There were 11 cases of fever and 2 cases of no rise in temperature.There were 23 cases of abdominal distension(100%),21 cases of vomiting(91.3%)and 11 cases of gastrointestinal hemorrhage(47.8%).Abdominal redness and swelling in 9 cases(39.1%);13 cases of abdominal wall tenderness(56.3%);11 cases(47.8%)had no bowel sounds.One case(4.3%)with airway excretion was detected in rectum finger.There were 8 cases of pneumoperitoneum,(34:8%),6 cases of intestinal wall gas'(26.1%),18 cases of intestinal tube stiffness(78.3%),16 cases of intestinal wall space thickening(69.6%),2.cases of colonic expansion(8.7%),16 cases of intestinal obstruction(69.6%),and 4 cases of portal vein gas(17.4%).3 Treatment and prognosisPatients on Bell stage ? or stage ? were improved after conservative treatment;Surgical treatment was performed in 17 children on Bell stage ?.Totally,21 cases were cured,1 case quited treatment and 1 case died.4 Research ConclusionPatients with NEC complicated with HD disease are not uncommon,and their clinical and imaging manifestations are not specific.Rectal biopsy is an important method for diagnosis,and early diagnosis is of significance for surgical selection and improvement of prognosis.Chapter 2 Clincal Relationship between Hirschsprung's disease andneonatal necrotizing enterocolitisResearch ObjectiveTo explore the Clincal relationship between Hirschsprung's disease and neonatal necrotizing enterocolitis.Materials and methods1 Case selectionA retrospective analysis of 289 consecutive neonatal NEC cases was made from January 2010 to December 2017 in zhongshan boai hospital of southern medical university.According to rectal biopsy of abnormal,(pathological prompt rectal muscular layer did not found the ganglion cells),23 patients with the diagnosis of NEC with HD were divided into the study group,while the other 266 cases of NEC did't comb:ined with HD were set as the control group.All the families of the children who underwent surgical treatment signed the consent for biopsy and surgery.The study was.approved by the ethics committee of zhongshan boai hospital of southern medical university.2 Methods2.1 clinical data collection:the gestational age,birth weight,feeding method,gender,age of onset,clinical manifestations,laboratory test results and abdominal X-ray manifestations of NEC patients with HD and control group were collected.2.2 clinical staging:patients were graded according to the Bell staging standard.2.3 treatment measures:conservative treatment and surgical treatment.3 Statistical processingSPSS 19.0 software was used for statistical analysis.The measurement data of normal distribution were expressed as mean plus or minus standard deviation,while the measurement data of non-normal distribution were expressed as median and quartile spacing.The chi-square test was used for comparison of rates between the two groups,and p<0.05 was considered statistically significant.4 Results4.1.statistical analysis of the incidence of 1HD and NEC suggests that a correlation between HD and NEC.(?2= 42.913,p<0.01).4.2.The basic data of the two groups were compared,and it was found that the gestational age and severity(Bell stage)of NEC wtih HD group were higher than those of NEC non-hd group(?2=7.385,34.587;.p=0.007,<0.001),and there was no significant difference in gender and birth weight between the two groups.4.3.The perinatal data of the two groups were compared,and the results suggested that the perinatal asphyxia of the NEC with HD group was significantly lower than that of the NEC non-hd group(?2=14.260,p<0.001),and there was no statistically significant difference between the two groups in terms of delivery mode.feeding mode and prenatal application of antibiotics.4.4.The clinical manifestations of the two groups were compared,and the results suggested that the abdominal distension and vomiting symptoms of NEC with HD group were significantly higher than those of NEC non-hd group(?2=32.327,24.686;p<0.001),and the onset of fever or no rise in body temperature was less than that of NEC non-hd group(?2= 4.190,p =0.041).There were no statistically significant differences between the two groups in the factors of gastrointestinal hemorrhage,abdominal wall tenderness,abdominal mass,disappearance of bowel sounds,airway ejection and shock between rectum.4.5.Compared the laboratory tests of the two groups of children,the results showed that the increase of CRP in the NEC wtih HD group was significantly higher than that in the NEC non-HD group(?2=11.931;p<=0.001).and the fever or body temperature is less than that of the NEC non-HD group(?2=4.190,p=0.041).There were no statistically significant differences between the two groups in factors such as abnormal white blood cells,significantly decreased platelets,positive rate of blood culture,and fecal occult blood.4.6.Abdominal X-ray examinations were compared between the two groups of children,and it was found that the patients in the NEC with HD group and those in the intestinal obstruction group were more significant than those in the NEC no-HD group,with more digestive tract perforation(pneumogastric)(?2=31.764,9.190;p=0,0.002).There was no statistically significant difference between the two groups in terms of ascites,intestinal wall gas,intestinal tube stiffness,intestinal wall space thickening,colonic dilation,and portal vein gas.4.7.There was no significant statistical difference in the prognosis factors(cure rate and mortality rate)between the two groups.5 Research ConclusionHD is associated with the onset of NEC.The,clinical condition of NEC patients with HD is more serious than those without HD.When treating NEC patients,it is necessary to be alert to the presence of HD.