不同喂养方式对足月新生儿坏死性小肠结肠炎临床特点及预后的影响

The influence of different feeding methods on clinical features and prognosis in term infants with necrotizing enterocolitis

目的分析不同喂养方式对足月新生儿坏死性小肠结肠炎(NEC)临床特点及预后的影响,为NEC的治疗提供科学依据。方法回顾性分析2016年1月-2020年12月首都医科大学附属北京儿童医院新生儿中心收治的足月NEC患儿资料,根据起病前喂养方式,分为母乳喂养组、混合喂养组及配方奶喂养组。比较三组间一般情况、起病情况/基础疾病、住院经过、疾病转归,并对预后不良的危险因素进行分析。结果共纳入足月NEC患儿275例,其中母乳喂养69例(25.1%),混合喂养118例(42.9%),配方奶喂养88例(32.0%)。配方奶喂养组起病日龄中位数为6 d,小于母乳喂养及混合喂养组(H=41.415,P<0.001),其NECⅢ期(P_(确切概率)=0.008)、CRP升高、血小板减少及合并腹膜炎、败血症比例,均高于母乳喂养组和混合喂养组(χ^(2)=32.273、15.158、15.329,P<0.05)。配方奶喂养组合并呼吸衰竭(P确切概率=0.006)、电解质紊乱(χ^(2)=7.522,P=0.023)、休克(P_(确切概率)=0.003)的比例显著高于混合喂养组。配方奶喂养组治愈率低于母乳喂养及混合喂养组(89.8%vs.94.2%、98.3%,χ^(2)=7.137,P=0.028)。Logistic回归分析显示,足月NEC合并休克(OR=9.598,95%CI:1.507~61.112)、代谢性酸中毒(OR=6.632,95%CI:1.693~25.974)及NECⅢ期(OR=17.180,95%CI:1.402~210.524)是NEC预后不良的独立危险因素(P<0.05)。结论合理的母乳喂养可以推迟足月NEC的发生,配方奶喂养的足月NEC患儿病情更为严重,合并症多见,治疗预后更差。

Objective To study the influence of different feeding methods on clinical features and prognosis of term infants with necrotizing enterocolitis(NEC),in order to provide scientific reference for the treatment of NEC.Methods Clinical data of term infants with NEC in Beijing Children's Hospital from January 2016 to December 2020 was retrospectively analyzed.According to the feeding methods before the onset of the disease,the patients were divided into breastfeeding group,mixed feeding group and formula feeding group.The general situations,onset diseases,hospitalization process and disease outcomes were compared among the three groups,and the risk factors of poor prognosis were analyzed.Results A total of 275 full-term infants with NEC were enrolled in the study,including 69(25.1%)cases in breastfeeding group,118(42.9%)cases in mixed feeding group and 88(32.0%)cases in formula feeding group.The median age of the onset of disease was 6 days old in the formula feeding group,earlier than breastfeeding and mixed feeding groups(H=41.415,P<0.001).The proportions of NEC Ⅲ stage,elevated CRP level(χ^(2)=32.273),thrombocytopenia(χ^(2)=15.158),peritonitis and sepsis(χ^(2)=15.329)in formula feeding group were higher than those of the other two groups(P<0.05).The proportions of patients with respiratory failure,electrolyte disorder and shock were higher than those of mixed feeding group(P<0.05).The mortality rates of formula feeding group were higher than that of other two groups(89.8%vs.94.2%,98.3%,χ^(2)=7.137,P=0.028).Logistic regression analysis showed that full-term NEC combined with shock(OR=9.598,95%CI:1.507-61.112),metabolic acidosis(OR=6.632,95%CI:1.693-25.974)and NEC Ⅲ stage(OR=17.180,95%CI:1.402-210.524)were risk factors for poor prognosis of NEC(P<0.05).Conclusions Reasonable breastfeeding can delay the occurrence of full-term NEC.The NEC condition of term infants with formula feeding is poorer,mainly with more complications and worse prognosis.