| Necrotizing enterocolitis is one of the most serious gastrointestinal diseases in neonatal.It is most occur in premature infants.With more and more births of premature and the very low birth weight infants,the incidence of the disease even increased this year.The incidence of very low birth weight infants is 5-10%,and the surgical mortality rate is as high as 30%,the 2011 domestic survey also showed that the incidence of NEC was 5.8%in very low birth weight infants.The early clinical manifestations of the disease are mainly atypical gastrointestinal symptoms such as abdominal distension and blood in the stool,and a part of children went to die in a rapid progress after the onset.the prognosis of some surviving children often involves serious complications.so early identification.diagnosing disease is especially important for reducing the incidence of neonatal necrotizing enterocolitis and improving the quality of life of surviving children.Methods:The clinical data of 72 children with NEC stage Ⅱ and stage Ⅲ diagnosed in the neonatal intensive care unit of Children’s Hospital of Zhejiang University School of Medicine were collected.The clinical characteristics,birth status,feeding mothods,and risk factors of disease stage were retrospective analysis.Quantitative data were expressed as mean and percentage,and qualitative data were compared using χ2 test,corrected χ2 test or fisher exact probability test.Results:(1)General situation:during the period of 20150101-20181231,72 patients with NEC of stage Ⅱ and stage Ⅲ were admitted to our hospital,including 46 males(63.89%),26 females(36.11%);average birth gestational age was(31.59±3.68)d,average birth weight was(1655.82 ± 663.59)g,18 cases(25.00%)were children with twins,Only 2 of them were identical twins;18 patients(25%)in stage Ⅱ,and 54 patients(75.00%)in stage Ⅲ.A total of 24 children(33.33%)died,1 patient died in stage Ⅱ,accounting for 5.56%of children in stage Ⅱ,and 23 patients died in stage Ⅲ,accounting for 42.59%of children in stage Ⅲ;Among them,51 patients(70.83%)received surgery and 21 patients(29.16%)underwent surgery,among them,12 patients died after surgery,accounting for 23.53%;12 patients did not undergo surgery,accounting for 57.14%.(2)The proportion of children in stage Ⅱ and stage Ⅲ of NEC to neonates admitted to our hospital during the same period:72 patients accounted for 2.33 ‰ of the newborns admitted to our hospital during the same period.from 2015 to 2018.the proportion was 2.63‰,3.10‰,1.65‰,1.84‰ each year.(3)Time of onset and corrected gestational age:The average time of onset was(14.81±9.72)d,the average corrected gestational age was(235.82±222.64)d,and the incidence of NEC was significantly concentrated in 31-33 weeks after corrected gestational age.(4)Clinical manifestations of neonatal necrotizing enterocolitis:72 cases(100%)with abdominal distension,48 cases(66.67%)with apnea,40 cases(55.56%)with blood in the stool,24 cases(33.33%)with gastric retention,13 cases(18.05%)with shock,11 cases(15.27%)with vomiting,9 cases(12.50%)with fever,and 9 cases(12.50%)with weakened and disappeared bowel sounds(5)The χ2 test showed that the difference between the feeding methods and the stage of the disease was statistically significant(P<0.05).There was no significant difference between the birth pattern of the child and the stage of the disease(P>0.05).Univariate analysis showed:pregnancy-induced hypertension,infectious factors,placenta.uterus abnormal,gestational diabetes,hyperthyroidism in pregnant mothers;the newbron with RDS,hypoglycemia,septicemia,prophylactic use of antibiotics before onset,There was no statistically significant difference between the stage of the disease and this possible influencing factors as above.(P>0.05)O(6)The results of abdominal X-ray examination in 72 children with NEC were as follows:4 cases with pneumoperitoneum(5.56%),65 cases with intestinal stiffness(90.28%),7 cases with intestinal obstruction(9.72%),and 10 cases with intestinal wall gas accumulation(13.89%).(7)The complications of 72 children with NEC included:11 cases with cholestasis(15.28%),10 cases with bronchopulmonary dysplasia(13.89%),4 cases with short bowel syndrome(5.56%),3 cases of retinopathy with prematurity(4.1 7%).Conclusions:(1)The corrected gestational age of children with NEC was mainly 31-33 weeks.(2)The early clinical manifestations of NEC were mainly abdominal distension,apnea and hematochezia,which had no specificity.(3)Feeding patterns affect the stages of NEC,It is suggested that breastfeeding should be implemented as soon as possible after birth.(4)The appearance of pneumoperitoneum as the operation time of NEC may cause hysteresis in the treatment of children. |
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