早产双胎之一发生坏死性小肠结肠炎的临床特征及危险因素分析

Analysis of clinical characteristic and risk factors for necrotizing enterocolitis in one of the premature twins

目的探讨早产双胎之一发生坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的临床特征及危险因素。方法选择2017年1月至2022年12月收入郑州大学第三附属医院新生儿科、仅一胎发生NEC的双胎早产儿进行回顾性分析,收集患儿临床资料,按照是否发生NEC分为NEC组和对照组,应用SPSS 26.0统计软件比较两组早产儿临床及辅助检查特点。结果共纳入双胎儿109对,其中NEC组、对照组各109例。NEC组出生体重、发病前血白细胞计数低于对照组,小于胎龄儿、双胎输血供血儿、发病前发生喂养不耐受、未达全肠内喂养、开奶时间>48 h、发病前72 h输红细胞和中性粒细胞比例高于对照组,差异有统计学意义(P<0.05)。多因素logistic分析显示,出生体重低(OR=1.558,95%CI1.197~2.142)、小于胎龄儿(OR=1.721,95%CI 1.217~2.536)、喂养不耐受(OR=3.798,95%CI 1.347~10.706)、未达全肠内喂养(OR=4.319,95%CI 1.673~11.149)是早产双胎之一发生NEC的独立危险因素(P<0.05)。结论出生体重低、小于胎龄儿、喂养不耐受和未达全肠内喂养是早产双胎之一发生NEC的独立危险因素。

Objective To study the clinical characteristics and risk factors of necrotizing enterocolitis(NEC)in one of the premature twins.Methods A retrospective study was conducted on twin premature infants who were admitted to the Department of Neonatology at the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2022 and only one got NEC.The twins were divided into NEC group and control group,the clinical data were collected and analyzed by SPSS 26.0 statistical software.Results This study enrolled 109 pairs of premature twins,109 cases in the NEC group,and 109 cases in the control group.Univariate analysis showed that birth weight,pre NEC white blood cell count were lower in NEC group than those in the control group,while the proportion of smaller than gestational age(SGA),donor of twin-to-twin transfusion syndrome,feeding intolerance,incomplete enteral feeding,start feeding time>48 h,red blood cell transfusion 72 h before NEC onset and the neutrophils ratio were higher in the NEC group than that of the control group,the difference was statistically significant(P<0.05).Multivariate logistic analysis showed that low birth weight(OR=1.558,95%CI1.197-2.142),SGA(OR=1.721,95%CI 1.217-2.536),feeding intolerance(OR=3.798,95%CI 1.347-10.706),and incomplete enteral feeding(OR=4.319,95%CI 1.673-11.149)were independent risk factors for NEC(P<0.05).Conclusions Low birth weight,small for gestational age,feeding intolerance,and incomplete enteral feeding are independent risk factors for NEC in one of the premature twins.