新生儿低血糖并发坏死性小肠结肠炎的临床特征分析

The analysis of clinical features of neonatal hypoglycemia complicated with necrotizing enterocolitis

目的探讨新生儿低血糖并发坏死性小肠结肠炎(necrotizing enterocolitis,NEC)患儿的临床特征、结局及其高危风险因素。方法本研究为回顾性分析,收集2014年1月至2019年12月厦门市妇幼保健院新生儿科住院的低血糖患儿临床资料,依据NEC诊断标准及Bell分级标准(Ⅱ-Ⅲ级)纳入研究组(21例),并通过1∶3倾向性评分匹配同期新生儿低血糖患儿且不符合NEC诊断标准的新生儿为对照组(63例)。对新生儿低血糖并发NEC者的母儿高危因素、临床症状、治疗方案及预后结局进行分析。采用χ^(2)检验、t检验、Kruskal-Wallis秩和检验进行统计分析。结果①NEC在生后7 d内发病者占比为81.0%(17/21),发病中位日龄为4 d;临床主要症状依次为血便、腹胀及纳差,住院时间7-34 d,治愈率为81.0%(17/21),预后不良率为19.0%(4/21),死亡率4.8%(1/21)。②研究组与对照组患儿多胎妊娠率[28.6%(6/21)与4.8%(3/63),χ^(2)=9.993]、剖宫产分娩率[95.2%(20/21)与60.3%(38/63),χ^(2)=8.987]比较,研究组高于对照组;胎龄[37.9(37.2,38.8)与38.9(38.1,40.0)周,Z=-3.198]、母乳喂养率[9.5%(2/21)与31.3%(20/63),χ^(2)=4.023]研究组低于对照组,差异均有统计学意义(P值均<0.05)。结论低血糖患儿合并NEC时发病日龄较早,血便为主要症状。对于胎龄<39周、多胎妊娠、剖宫产分娩及非母乳喂养的低血糖患儿应警惕NEC的发生。

Objective To investigate the clinical characteristics,outcomes and risk factors of infants with neonatal hypoglycemia complicated with necrotizing enterocolitis.Methods This study was a retrospective analysis.The clinical data of neonates with hypoglycemia were collected in Xiamen Maternal and Child Health Hospital from January 2014 to December 2019.According to NEC diagnostic criteria and Bell classification criteria(gradeⅡ-Ⅲ),the neonates with hypoglycemia were divided into study group(21 cases).At the same period,neonates suffering from hypoglycemia but did not meet NEC diagnostic criteria were divided into the control group(63 cases)matched by 1∶3 propensity score.The maternal risk factors,clinical symptoms,treatment and prognosis of neonatal hypoglycemia complicated with NEC during pregnancy were analyzed.χ^(2) test,t test and Kruskal-Wallis rank sum test were used for statistical analysis.Results①The proportion of NEC onset in the first 7 days of life was 81.0%(17/21),the median age of onset was 4 days after born.The main clinical symptoms were blood stool,abdominal distention and anepithymia.The cure rate was 81.0%(17/21),the poor prognostic rate was 19%(4/21),and the mortality rate was 4.8%(1/21).②The multiple pregnancy rate[28.6%(6/21)vs 4.8%(3/63),χ^(2)=9.993]and the cesarean delivery rate[95.2%(20/21)vs 60.3%(38/63),χ^(2)=8.987]in study group were significantly higher than those in control group.The gestational age[37.9(37.2,38.8)vs 38.9(38.1,40.0)weeks,Z=-3.198]and the breastfeeding rate[9.5%(2/21)vs 31.3%(20/63),χ^(2)=4.023]in study group were significantly lower,than those in control group,and the differences were statistically significant(all P<0.05).Conclusions The onset of NEC in children with hypoglycemia is earlier,bloody stool is the main symptoms.To reduce the incidence of NEC,more attention should be given to the hypoglycemic infants with gestational age less than 39 weeks,multiple pregnancy,cesarean section delivery and artificial feeding.