Effect Of Perioperative Glycemic Control On The Prognosis Of Neonates With Surgical Necrotizing Enterocolitis : A Retrospective Study

Background : Necrotizing enterocolitis(NEC)is one of the most common and devastating diseases that occurs in neonates,and often requires surgical intervention.Hyperglycemia or hypoglycemia can easily occur in newborns,due to their metabolic immaturity.It remains unknown how factors associated with anesthesia especially perioperative glucose level affect the surgical outcomes of neonates with NEC.In this retrospective observational study,we analyzed the risk factors associated with prolonged hospitalization among neonates who received surgical treatment for necrotizing enterocolitis.Methods:From January 2016 to October 2019,a total of 204 infants with a gestational age of 28 weeks to 40 weeks underwent open surgery for NEC at Shengjing Hospital of China Medical University.Those patients were divided into two groups according to their perioperative blood glucose level.Patients with a perioperative blood glucose concentration in the range of 47-150 mg/d L were designated as optimal glycemic control.Any two measurements(consecutive or non-consecutive)of blood glucose made 24 hours before,during or after the surgery,and whose values were not within the pre-specified range,were considered to indicate poor perioperative glycemic control.The primary study outcome was the length of postoperative hospital stay.Risk factors that may affect surgical outcomes were collected and analyzed via multivariate logistic regression to determine their association with postoperative hospital stay.Results:A multivariate logistic regression analysis showed that high preoperative weight(OR=0.995,95%CI=0.992-0.997,P<0.001)and optimal glycemic control(OR=0.129,95%CI=0.031-0.535,P=0.005)were independent protective factors for prolonged hospital stay,whereas long duration of endotracheal intubation in NICU(OR=1.239,95%CI=1.016-1.512,P=0.035)and long days of antibiotics use(OR=1.421,95%CI=1.233-1.637,P<0.001)were independent risk factors for prolonged hospital stay.Patients with perioperative blood glucose control within the prespecified range(47-150mg/d L)had shorter postoperative hospital stays than those with perioperative blood glucose measurements outside those limits(22 [18,26] vs 29[24.5,36.5] days,P <0.001).Conclusions: Optimal perioperative glucose control may shorten postoperative hospital stay and improve the prognosis of neonates with surgical necrotizing enterocolitis.