Analysis Of The Clinical Characteristics And Risk Factos In Neonates With Neonatal Necrotizing Enterocolitis

Objective:To explore the incidence of necrotizing enterocolitis(NEC)in neonatal intensive care unit(NICU)of the First Affiliated Hospital of Xinjiang Medical University from January 2023 to December 2022.To analyze the risk factors affecting the occurrence and progression to need for surgical intervention,thereby providing a theoretical basis for the clinical prevention and treatment of NEC and maximizing the survival quality of children.Methods:In this study,a single center retrospective study,clinical data of 376 children diagnosed with NEC during 10 years in our NICU were collected as the case group,and1880 non NEC children hospitalized during the same period were randomly selected as the control group,for a total of 2256 clinical data,to compare the two groups of children’s conditions,maternal diseases,premorbid conditions,and treatment conditions before onset,and to analyze the risk factors for developing NEC using multivariate logistic regression.In addition,children with confirmed NEC who required surgical treatment were divided into medical and surgical groups,and all exposure factors were analyzed.Result:(1)Among 17180 neonates admitted to our NICU over a 10-year period,376 were affected with NEC(including stage I),and the incidence of NEC was 2.19%,including232(61.7%)with NEC stage I,87(23.1%)with stage II,and 57(15.2%)with stage III.The incidence of NEC was 11.43%(126 / 1102)in very low birth weight(VLBW)and11.25%(18 / 160)in extremely low birth weight(ELBW)infants over a 10-year period.(2)Among 376 children with NEC,319(84.8%)were managed conservatively by internal medicine and 57(15.2%)reached the indication for surgical treatment,27 of whom survived surgical intervention,were not conditioned to tolerate surgery,abandoned surgical treatment or were found to have extensive necrosis of the bowel intraoperatively and progressed to death outcomes.29 the case fatality rate for NEC was 7.7%.(3)The results of univariate analysis of data between the NEC and non NEC groups suggested that multiple births,small for gestational age infants,amniotic fluid contamination,premature rupture of membranes,intrapartum asphyxia,NRDS,sepsis,blood transfusion before onset,use of ventilator,UVC,and breastfeeding were associated with the development of NEC(P<0.05).Further logistic multivariate analysis of these 11 statistically significant univariate variables suggested small for gestational age,intrapartum asphyxia,sepsis,use of a ventilator as risk factors for developing NEC and breastfeeding as protective factors for NEC.(4)The results of the analysis of data between the medical and surgical groups suggested that NRDS,combined shock,elevated CRP at onset,neutropenia,positive blood / fecal occult blood,and abdominal distension were risk factors for the development of NEC in children requiring surgical intervention.Conclusions:The occurrence of NEC is influenced by several factors,small for gestational age,intrapartum asphyxia,sepsis,and the use of a ventilator being new risk factors for the development of NEC in neonates.NRDS,shock,elevated CRP at onset,neutropenia and abdominal distension at onset,positive bloody stools / fecal occult blood are risk factors for the development of NEC to need surgical treatment and should be actively prevented to improve the prognosis.Breast feeding is a protective factor for NEC and should be actively advocated.