Analysis Of Risk Factors And Establishment Of Prediction Models For Surgical Treatment Of Neonatal Necrotizing Enterocolitis

Objective:The medical records of 215 cases of neonatal necrotizing enterocolitis(NEC)were analyzed retrospectively to summarize the clinical characteristics of children with NEC who underwent surgery,to discuss the factors affecting the surgical opportunity,and to establish a predictive model for surgery that can be visually assessed.Methods:A total of 215 children diagnosed with NEC admitted to the Affiliated Hospital of Qingdao University between January 2011 and January 2021 were collected,of which 43 children who received surgical treatment were in the surgical group,and 172 children who received only conservative treatment in a similar period to the surgical group were selected to form the non-surgical group.We analyzed and compared the general condition,clinical manifestations(e.g.,abdominal distension,abdominal wall redness),serological indicators(e.g.,white blood cell count),intraoperative condition,feeding time,complication rate,and length of hospitalization of the children in the two groups.The clinical data were analyzed univariately to find out the possible risk factors.The independent risk factors influencing the surgical decision were analyzed using logistic regression,while the interrelationship of the risk factors in the logistic model was expressed visually by establishing a column line diagram to represent them.On this basis,the model fitting effect was evaluated pragmatically by the area under the receiver operating characteristic(ROC)curve and the goodness-of-fit was verified.Results:Logistic univariate and multifactorial regression analysis showed that very low body weight,reduced PLT,acidosis,sepsis,Duke score≥7,and abdominal wall erythema were independent factors influencing the difference in surgical opportunity(P < 0.05);on the basis of this data,R software was applied to plot the relevant column line graphs.The area under the ROC curve of this surgical opportunity prediction model was 0.919;the Hosmer-Leme show goodness-of-fit test,which assesses the accuracy of the prediction model,yieldedc2=12.473,P=0.131;plotting the column line graph calibration curve,the slope of which can be observed to be close to 1.Conclusion:In this study,six risk factors affecting the surgical opportunity in children with NEC were obtained by applying the corresponding multi-statistical methods of research and validation to clinical data,and the obtained column line graphs of the prediction model for the surgical opportunity have good accuracy,which has a certain clinical reference value for the quantitative selection of the surgical opportunity in children with NEC.