新生儿坏死性小肠结肠炎患儿的远期预后

doi:10.7499/j.issn.1008-8830.2018.12.002

摘要
图/表
参考文献(24)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (1089 KB) HTML()
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的了解新生儿坏死性小肠结肠炎（NEC）患儿的远期预后。方法将2014年12月至2016年9月存活出院的83例NEC早产儿分为手术组（n=57）和非手术组（n=26）。手术组Ⅰ期、Ⅱ期、Ⅲ期NEC患儿分别有0、33、24例，非手术组分别有7、19、0例。对患儿出院后体格发育、神经系统发育等情况进行随访分析。结果 83例患儿随访结束时平均纠正年龄为21±6个月。31例（37%）体重落后，其中手术组体重落后率高于非手术组（P < 0.05）；22例（27%）身长落后；14例（17%）头围落后。运动发育落后/发育障碍患儿共18例（22%），其中手术组发生率高于非手术组（28% vs 8%，P < 0.05）。共有5例（6%）患儿诊断为脑瘫，其中手术组4例，非手术组1例。结论 NEC会影响患儿的远期体格发育及神经系统发育等，尤其对病情严重需接受手术治疗的患儿影响更大，应对NEC患儿进行长期随访。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	林慧佳
	施丽萍
	杜立中

关键词 ：坏死性小肠结肠炎, 随访, 预后, 早产儿

Abstract：Objective To investigate the long-term prognosis of neonates with necrotizing enterocolitis (NEC).Methods A total of 83 preterm infants with NEC who survived and were discharged between December 2014 and September 2016 were enrolled and divided into surgery group (n=57) and non-surgery group (n=26). There were 0, 33 and 24 cases of stage I, Ⅱ and Ⅲ NEC respectively in the surgery group and 7, 19 and 0 cases respectively in the non-surgery group. The physical development and neurodevelopmental outcomes of the infants were followed up after discharge.Results Of the 83 infants, the mean corrected age at the end of follow-up was 21±6 months. Of the 83 infants, 31 (37%) had subnormal body weight, and the surgery group had a higher rate of subnormal body weight than the non-surgery group (P < 0.05). Twenty-two infants (27%) had subnormal body length and 14 children (17%) had subnormal head circumference among the 83 infants. Eighteen infants (22%) had motor developmental delay/developmental disorders, and the surgery group had a higher incidence rate of the disorders than the non-surgery group (28% vs 8%; P < 0.05). Five infants (6%) were diagnosed with cerebral palsy, among whom 4 were in the surgery group and 1 was in the non-surgery group.Conclusions Long-term physical development and neurodevelopmental outcomes may be adversely affected in neonates with NEC, in particular in those with severe conditions who need surgical treatment, suggesting that long-term follow-up should be performed for neonates with NEC.

Key words： Necrotizing enterocolitis Follow-up Prognosis Preterm infant

收稿日期: 2018-07-12

基金资助:2017年浙江省医药卫生科技计划项目（2017KY432）。

通讯作者: 杜立中,男,主任医师,教授。Email:dulizhong@zju.edu.cn E-mail: dulizhong@zju.edu.cn

作者简介: 林慧佳,女,硕士,副主任医师。

引用本文:

林慧佳,施丽萍,杜立中. 新生儿坏死性小肠结肠炎患儿的远期预后[J]. 中国当代儿科杂志, 2018, 20(12): 985-989.

LIN Hui-Jia,SHI Li-Ping,DU Li-Zhong. Long-term prognosis of neonates with necrotizing enterocolitis[J]. CJCP, 2018, 20(12): 985-989.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2018.12.002 或 http://www.zgddek.com/CN/Y2018/V20/I12/985

[1]	胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第7版. 北京:人民卫生出版社, 2005:475-477.
[2]	Eltayeb AA, Mostafa MM, Ibrahim NH, et al. The role of surgery in management of necrotizing enterocolitis[J]. Int J Surg, 2010, 8(6):458-461.
[3]	Neu J, Walker WA. Necrotizing enterocolitis[J]. N Engl J Med, 2011, 364(3):255-264.
[4]	Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging[J]. Ann Surg, 1978, 187(1):1-7.
[5]	WHO. WHO Child Growth Standards:methods and development[EB/OL].[2018-06-10].
[6]	Cloherty JP, Eichenwald EC, Hansen AR, et al. Manual of Neonatal Care[M]. 7th ed. Philadelphia:Little, Brown and Company, 2012:762-766.
[7]	中国短肠综合征治疗协作组. 中国短肠综合征诊疗共识(2016年版)[J]. 中华医学杂志, 2017, 97(8):569-576.
[8]	刘振寰, 戴淑凤. 儿童运动发育迟缓康复训练图谱[M]. 第7版. 北京:北京大学医学出版社, 2007:7-9.
[9]	唐久来. 常见中枢性运动发育落后/障碍的规范化诊断[J]. 中国儿童保健杂志, 2013, 21(7):673-675.
[10]	唐久来, 秦炯, 邹丽萍, 等. 中国脑性瘫痪康复指南(2015):第一部分[J]. 中国康复医学杂志, 2015, 30(7):747-754.
[11]	Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories[J]. J Pediatr Surg, 2009, 44(6):1072-1075.
[12]	Lin HJ, Du LZ, Ma XL, et al. Mortality and morbidity of extremely low birth weight infants in the mainland of China:a multi-center study[J]. Chin Med J (Engl), 2015, 128(20):2743-2750.
[13]	林慧佳, 马晓路, 施丽萍, 等. 危重评分预测新生儿坏死性小肠结肠炎预后62例回顾分析[J]. 中华儿科杂志, 2013, 51(5):326-330.
[14]	王陈红, 施丽萍, 吴秀静, 等. 早产儿胃肠外营养相关性胆汁淤积症的临床特征[J]. 中华儿科杂志, 2011, 49(3):199-202.
[15]	Petty JK, Ziegler MM. Operative strategies for necrotizing enterocolitis:the prevention and treatment of short-bowel syndrome[J]. Semin Pediatr Surg, 2005, 14(3):191-198.
[16]	Lawlor DA, Batty GD, Morton SM, et al. Early life predictors of childhood intelligence:evidence from the Aberdeen children of the 1950s study[J]. J Epidemiol Community Health, 2005, 59(8):656-663.
[17]	Walsh MC, Kliegman RM, Hack M. Severity of necrotizing enterocolitis:influence on outcome at 2 years of age[J]. Pediatrics, 1989, 84(5):808-814.
[18]	Salhab WA, Periman JM, Sliver L, et al. Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants <1000 g[J]. J Perinatol, 2004, 24(9):534-540.
[19]	Hintz SR, Kendrick DE, Stoll BJ, et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis[J]. Pediatrics, 2005, 115(3):696-703.
[20]	Sonntag J, Grimmer I, Scholz T, et al. Growth and neuro-developmental outcome of very low birthweight infants with necrotizing enterocolitis[J]. Acta Paediatr, 2000, 89(5):528-532.
[21]	Dilli D, Eras Z, Özkan Ulu H, et al. Does necrotizing enterocolitis affect growth and neurodevelopmental outcome in very low birth weight infants?[J]. Pediatr Surg Int, 2012, 28(5):471-476.
[22]	Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis[J]. Arch Dis Child Fetal Neonatal Ed, 2007, 92(3):F193-F198.
[23]	Arnold M, Moore SW, Sidler D, et al. Long-term outcome of surgically managed necrotizing enterocolitis in a developing country[J]. Pediatr Surg Int, 2010, 26(4):355-360.
[24]	Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis:a systematic review of observational studies[J]. Arch Pediatr Adolesc Med, 2007, 161(6):583-590.