新生儿坏死性小肠结肠炎并发神经发育障碍的危险因素研究

Risk Factors for Adverse Neurodevelopment Outcomes in Neonates with Necrotizing Enterocolitis

背景新生儿坏死性小肠结肠炎(NEC)会影响患儿远期神经发育情况,目前关于NEC并发不良神经结局的危险因素的研究较少。目的探讨新生儿NEC并发神经发育障碍的危险因素。方法选取2019年1月至2020年6月于郑州大学第三附属医院新生儿科就诊并确诊为Ⅱ~Ⅲ期NEC的早产儿为研究对象。记录患儿的新生儿一般情况、母亲孕期合并症、新生儿期并发症。所有患儿随访至纠正年龄1岁,并采用贝利婴幼儿发展量表Ⅲ(BSID-Ⅲ)进行神经发育评估,依据评估结果将患儿分为神经发育障碍组和神经发育正常组。采用多因素Logistic回归分析探究NEC患儿并发神经发育障碍的危险因素。结果本研究共纳入Ⅱ~Ⅲ期NEC患儿236例,其中死亡23例、失访13例,完成随访200例。200例患儿中神经发育障碍21例(10.5%,神经发育障碍组),神经发育正常179例(89.5%,神经发育正常组)。神经发育障碍组患儿出生体质量低于神经发育正常组,败血症、肠穿孔、短肠综合征发生率高于神经发育正常组(P<0.05)。多因素Logistic回归分析结果显示,出生体质量<1000 g〔OR=4.603,95%CI(1.220,17.365),P=0.024〕、败血症〔OR=4.401,95%CI(1.191,16.262),P=0.026〕、肠穿孔〔OR=5.239,95%CI(1.522,18.029),P=0.009〕是NEC患儿并发神经发育障碍的独立危险因素。结论出生体质量<1000 g、败血症、肠穿孔是NEC患儿并发神经发育障碍的危险因素,新生儿科医生应高度重视,注意早期识别和预防,以降低NEC伤残率。

Background Neonatal necrotizing enterocolitis(NEC)adversely affects the long-term neurodevelopmental outcomes of preterm infants.However,few studies concerning the risk factors for neurodevelopmental outcomes in preterm infants with NEC have been conducted.Objective To investigate the risk factors for adverse neurodevelopmental outcomes of NEC in preterm infants.Methods Preterm infants diagnosed with stageⅡtoⅢNEC in Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University from January 2019 to June 2020 were included.General conditions and neonatal complications of the infants,as well as pregnancy-related complications of the mothers were obtained.All infants were followed up to a corrected age of 12 months,at which the neurodevelopmental outcome was evaluated by the Bayley Scales of Infant DevelopmentⅢ(BSID-Ⅲ),and in accordance with the evaluation results,the infants were divided into a normal group and an adverse neurodevelopment outcome group.Multivariate Logistic regression analysis was performed to investigate the risk factors for adverse neurodevelopmental outcomes.Results Of the 236 infants included,23 died,and 13 were lost to follow up,the other 200 cases who completed the follow-up were finally included for analysis,including 21(10.5%)with neurodevelopmental disorders(adverse neurodevelopmental outcome group),and 179(89.5%)with normal neurodevelopmental outcome(normal group).Compared with infants with normal neurodevelopmental outcome,those with neurodevelopmental disorders had lower mean birth weight,and higher incidence of sepsis,intestinal perforation,and short bowel syndrome(P<0.05).Univariate analysis revealed that,compared to infants with normal neurodevelopmental outcome,those with neurodevelopmental disorders had lower mean birth weight,and higher incidence of sepsis,bowel perforation and short bowel syndrome(P<0.05).Multivariate Logistic regression analysis indicated that birth weight<1000 g〔OR=4.603,95%CI(1.220,17.365),P=0.024〕,sepsis〔OR=4.401,95%CI(1.191,16.262),P=0.026〕and bowel perforation〔OR=5.239,95%CI(1.522,18.029),P=0.009〕were independently associated with increased risk factor of adverse neurodevelopmental outcomes.Conclusion Birth weight less than 1000 g,sepsis and bowel perforation may be risk factors for adverse neurodevelopmental outcomes in preterm infants with NEC,which should be significantly valued by newborn pediatricians for the prevention or early identification of NEC,thereby reducing the rate of NEC-caused disabilities.