The Analysis Of Diagnosis And Treatment Of Neonatal Necrotizing Enterocolitis In Single-center In The Last Ten-years

Objective:Collect the clinical data of neonates necrotizing enterocolitis(NEC)in Children's Hospital of Soochow University,to investigate the progress of NEC and the risk factors related to surgical treatment,and to identify the influential factors of NEC developed to severe form as clinical treatment.The evaluation of operation and the judgement of prognosis provide theoretical basis.Methods:From January 2009 to January 2019,the clinical data of children with NEC who were admitted to Children's Hospital of Soochow University were retrospectively analyzed.Among them,4 cases were hospitalized in the other hospital.Lack of clinical performance of onset and laboratory examination were completely excluded,21 cases were excluded because the prognosis was unknown,the remaining 296 cases were included in the statistics of prognosis and surgical risk factors.General data,such as name,sex,birth weight,perinatal data,clinical manifestations at the onset of the disease,medication and treatment,complications related to neonatal period,auxiliary examination and prognosis,etc.,were collected.SPSS 23.0 statistical software was used for data processing to analyze the influence of various factors on the progress of NEC and the choice of treatment methods,and to explore the risk factors affecting prognosis and operation.Results:1.Patient admission:A total of 321 children with confirmed NEC who were hospitalized in the Children's Hospital of Soochow University from January 2009 to January 2019 were collected.In the past decade,the number of children with NEC treated and operated on showed an upward trend.2.General situation:239 premature infants(80.7%)and 57 full-term infants(19.3%).The hospitalization time of premature infants was longer than that of full-term infants(p<0.05).The onset age of premature infants was older than that of full-term infants(p<0.05),the earlier the infants were born,the later the illness was likely to occur.3.According to Bell's staging criteria,there were 157 cases in stage I,56 cases in stage II and 83 cases in stage III.The operation rate in stage III was 65.1%and the mortality rate was 62.7%.Bell's prognosis in different stages and whether or not surgical treatment were significantly different(p<0.05).The higher the stage,the worse the prognosis,the greater possibility of surgery.4.The most common clinical manifestation of NEC is abdominal distention.Secondly,abnormal blood stool and body temperature.The death group had more children with intestinal sounds disappearance,peritonitis and abdominal wall erythema than the cure group(p<0.05).The incidence of surgical treatment for these signs was also relatively high.5.Neonatal sepsis,respiratory failure and neonatal scleredema were significantly more in the death group than in the cure group(p<0.05),and neonatal sepsis was significantly more in the operation group than in the conservative group(p<0.05).Neonatal jaundice in the death group was significantly less than that in the cure group,and its proportion in the operation group was also less than that in the conservative group(p<0.05).6.The proportion of leukocyte abnormalities and thrombocytopenia increased significantly in the death group and in the operation group(p<0.05),but it was not an independent risk factor for operation and prognosis.7.In multivariate analysis,neonatal sepsis,peritonitis and acidosis were independent risk factors for NEC death,and neonatal jaundice was the protective factor for death.The disappearance of bowel sounds,peritonitis,CRP and DAAS>7 were independent risk factors for surgical treatment.8.69 cases were treated surgically,the operation rate was 23.31%.Among them,43 cases were cured,the cure rate was 62.32%,the postoperative mortality rate was 37.7%.The most common surgical method was enterostomy(41 cases,59.4%).The most common surgical indication was pneumoperitoneum(25 cases,36.2%).8 cases of intestinal stricture after conservative treatment,the rate of intestinal stricture after conservative treatment was 3.5%.9.There was no significant difference in the prognosis of surgical treatment in general,clinical manifestations,related complications,special medication and laboratory examination,but it was related to surgical indications,choice of surgical methods and operation decision-making time(p<0.05).Conclusion:1.Necrotizing enterocolitis is most common in premature infants.The incidence of NEC and the number of operations have increased in the past decade,but the mortality rate has not improved significantly.2.The higher the Bell stage,the worse the condition and the higher the risk of surgery.3.Neonatal sepsis,peritonitis and acidosis are independent risk factors for NEC mortality,and neonatal jaundice is the protective factor for NEC mortality.The disappearance of bowel sounds,peritonitis,CRP and DAAS>7 are independent risk factors for surgical treatment.