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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (2): 122-125.

• 论著 • 上一篇    下一篇

胎龄小于34周早产儿坏死性小肠结肠炎危险因素的病例对照研究

程舒鹏 芦起 周敏 余加林   

  1. 重庆医科大学附属儿童医院新生儿科，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室 重庆，400014
  • 收稿日期:2016-03-01 修回日期:2016-04-21 出版日期:2016-04-25 发布日期:2016-04-21
  • 通讯作者: 芦起

Risk factors for necrotizing enterocolitis in gestational age < 34 weeks preterm neonates: a case-control study

CHENG Shu-peng, LU Qi, ZHOU Min, YU Jia-lin   

  1. Department of Neonatology, Children's Hospital, Chongqing Medical University, and Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China
  • Received:2016-03-01 Revised:2016-04-21 Online:2016-04-25 Published:2016-04-21
  • Contact: LU Qi

PDF

2086

被引次数

22

摘要：

目的 探讨胎龄<34周的早产儿发生坏死性小肠结肠炎（NEC）的危险因素。方法 纳入2010 年3月至2015年3月重庆医科大学附属儿童医院NICU住院的、胎龄<34周的Bell分期≥Ⅱ期的NEC早产儿，以同期NICU住院的非NEC早产儿为对照组，样本量对照组与NEC组2∶1。截取母孕期肝内胆汁淤积症(ICP)、生后窒息、家族过敏史、母乳喂养、胎粪吸入综合征、先天性心脏病、败血症、输血和口服益生菌等因素行单因素分析和多因素logistic回归分析，考察发生NEC的危险因素。结果 NEC组纳入66例（Ⅱ期50例，Ⅲ期16例），非NEC组132例早产儿进入本文分析。两组早产儿性别、胎龄、出生体重、分娩方式和出生地点等基线资料差异均无统计学意义( P＞0.05)。NEC病例在1月份发病最多（9例），8月份最少（2例）。66例NEC患儿发病在生后2~27 d，平均为15.5 d 。单因素和多因素Logistic回归分析均显示母孕期ICP（OR=2.38,95%CI:1.74~5.49）、输血（OR=3.33,95%CI:1.76~5.78）、新生儿窒息(OR=2.49,95%CI:1.69~4.95)和败血症（OR=4.05,95%CI:2.01~6.87）可增加NEC的发病风险，口服益生菌为NEC发生的保护因素（OR=0.91,95%CI:0.48~0.94）。结论 母孕期ICP、新生儿窒息、败血症和输血可增加胎龄<34周早产儿NEC的患病风险，口服益生菌为NEC的保护因素。

Abstract:

Objective To evaluate the risk factors for NEC in gestational age (GA)<34 weeks neonates. Methods Risk factors associated with NEC were investigated using a retrospective case-control design. Patients with Bell′s stage NEC ≥Ⅱ were identified between 1st March 2010 and 1st March 2015. Each case was paired with two GA- and weight-matched controls. Data were collected from medical records,including ICP, asphyxia after birth, family allergy history, breast feeding, MAS, sepsis, CHD, probiotics and transfusion of PRBC, and univariate and logistic regression analyses employed to analyze the risk factors related to NEC. Results A total of 66 cases and 132 controls were enrolled.The demographic characteristics of the two groups were not statistically significant. The onset time of 66 cases was 2-27 d after birth and the average time was 15.5 d. Variation in months after NEC was diagnosed was noted, with a peak in January (9 cases) and a trough in August (2 cases). Intrahepatic cholestasis of pregnancy (ICP) （OR=2.38,95%CI:1.74-5.49）,transfusion with packed red blood cells (PRBCs) （OR=3.33,95%CI:1.76-5.78）,postnatal asphyxia (OR=2.49,95%CI:1.69-4.95) and sepsis （OR=4.05,95%CI:2.01-6.87） were significantly associated with NEC. Probiotic use was protective factor. Conclusion A seasonal variation in months in babies with NEC was observed. A range of conditions was found to be associated with an increased risk of NEC under 34 weeks′ gestation. IICP, asphyxia after birth, sepsis and transfusion of PRBC were found to be associated with an increased risk of NEC under 34 weeks′ gestation. Probiotics was a protective factor.