| Objective:To explore the influential factors and correlation of Necrotizing enterocolitis(NEC)in newborns with different birth weights.Method:Ninety-one neonates diagnosed with necrotizing enterocolitis in the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital from January 2017 to December 2021 according to Bell staging criteria were selected,grouped according to birth weight,and related clinical data were collected before,during and after delivery.A total of 207 non-NEC neonates of the same gestational age and weight who were hospitalized in the same period were compared.The influencing factors of different birth weight groups were investigated,and the relationship of influencing factors among different birth weight groups was explored.At the same time,auxiliary test data of each NEC group were collected before,during and after diagnosis of NEC,and predictive indicators with warning significance were found by comparing before,during and after diagnosis of NEC.Results:1.General information of NEC cases: There were statistical differences in the onset time of NEC between the ultra-low and very low birth weight groups,the low birth weight group and the normal birth weight group(P<0.05),the lower the birth weight,the smaller the gestational age and the later the onset time,that is to say,the onset time was negatively correlated with birth weight and gestational age,and more NEC‐III patients chose surgical treatment(P<0.05).2.Comparison between NEC group and control group:(1)Low and very low birth weight infants: small head circumference in NEC children(P<0.05),the proportion of premature rupture of membranes was higher,and the Apgar score at 5 minutes was lower(P<0.05);The proportion of symptoms of abdominal distension,vomiting,undigested stool,unsolved stool and bloody stool was high(P<0.05);The levels of hemoglobin and blood phosphorus were higher,and the levels of platelet and creatinine/blood phosphorus were lower(P< 0.05);The proportion of clinical use of vitamin E,blood transfusion for more than 3 times,gastrointestinal power drugs and probiotics was low,the proportion of breast feeding was high,the proportion of premature infant milk and deeply hydrolyzed milk was low,and the proportion of patients treated with proglobulin was high(P< 0.05);The proportion of patients complicated with respiratory distress syndrome and congenital heart disease was small(P<0.05).(2)In the low birth weight group,the proportion of abnormal uterus in mothers of NEC children was higher(P< 0.05);The proportion of hydramnios was higher and the Apgar score was lower(P<0.05);The proportion of symptoms of abdominal distension,vomiting,undigested stool,unsolved stool and bloody stool was high(P<0.05);The levels of red blood cells,blood phosphorus,creatinine and procalcitonin were lower,and the levels of platelets and albumin were higher(P<0.05);The clinical use of vitamin E was low,and more patients were treated with proglobulin.Apnea and anemia were more common.(3)In the normal weight infants group,the proportion of abnormal uterus in the mothers of NEC children was higher,the age was older,and the proportion of cesarean section was higher(P<0.05);The symptoms of blood stools,abdominal distension and vomiting were high(P<0.05);Low hemoglobin,and blood calcium levels(P<0.05);The clinical use of restrictive antibiotics was high,and fewer patients were treated with gastrointestinal motogenic drugs.Partial hydrolyzed milk powder had fewer feeders and the feeding speed was slow(P<0.05);The proportion of patients complicated with hypoglycemia and anemia was higher,and the proportion complicated with patent foramen ovale or congenital heart disease was smaller(P< 0.05).3.Repeated comparison results within the NEC auxiliary test data set:(1)There were statistically significant differences in the levels of white blood cells,red blood cells,platelets,blood phosphorus,C-reactive protein,globulin and albumin in the ultra-low and very low birth weight infant groups before,at and after diagnosis(P<0.05).The pin-two comparison showed that the levels of leukocyte,blood phosphorus,C-reactive protein,globulin and albumin were significantly different before and after diagnosis(P<0.05);There were statistically significant differences in the levels of erythrocyte,blood phosphorus and albumin between diagnosis and after diagnosis(P<0.05).(2)Low birth weight infants: the levels of erythrocyte,hemoglobin,blood phosphorus,creatinine and C-reactive protein were significantly different before,at and after diagnosis(P<0.05).There were significant differences in the levels of hemoglobin,blood phosphorus,creatinine and C-reactive protein between before and after diagnosis(P< 0.05).(3)There were significant differences in the levels of serum phosphorus,creatinine/phosphorus,C-reactive protein and albumin in the normal weight infant group before diagnosis,at diagnosis and after diagnosis(P<0.05).There were significant differences in creatinine/blood phosphorus and albumin levels between the normal birth weight infants before and after diagnosis of NEC(P< 0.05);The levels of serum phosphorus,creatinine/phosphorus,C-reactive protein and albumin were significantly different before and after diagnosis(P< 0.05);The difference of C-reactive protein level between at diagnosis and after diagnosis was statistically significant(P<0.05).4.Results of regression analysis: Further regression analysis showed that small head circumference,vomiting symptoms and bloody stool symptoms were risk factors for ultra-low and very low birth weight infants with NEC(P<0.05);Blood transfusion,vitamin E,and feeding were protective factors for children with ultra-low and very low birth weight NEC(P<0.05).Hematostools are risk factors for NEC in low birth weight infants(P< 0.05),erythrocyte was a protective factor in low birth weight infants with NEC(P<0.05).Maternal age and abdominal distension as risk factors for normal birth weight infants with NEC(P< 0.05).Conclusions:Supplementation of vitamin E,breast-feeding,and blood transfusion may reduce the risk of NEC in ultra-low and very low birth weight infants.Small head circumference is a risk factor in ultra-low and very low birth weight infants.The relationship between adverse lifestyle during pregnancy and environment,head circumference,and NEC may be a focus for future attention.Maternal age is a risk factor for NEC in normal birth weight infants,and childbearing at the appropriate age can reduce the incidence of NEC in normal birth weight infants.The trend of laboratory indicators in the progression of NEC may be one of the distinguishing points between NEC and other severe neonatal diseases. |
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