早产儿坏死性小肠结肠炎影响因素分析及发病预测模型的构建

doi:10.7499/j.issn.1008-8830.2109086

Abstract
Figure/Table
References(27)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (754 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To investigate the risk factors for necrotizing enterocolitis (NEC) in preterm infants, and to establish a scoring model that can predict the development and guide the prevention of NEC. Methods A retrospective analysis was performed on the medical data of preterm infants who were admitted to the Department of Neonatology,Bethune First Hospital of Jilin University, from January 2011 to December 2020. These infants were divided into two groups: NEC (298 infants with Bell II stage or above) and non-NEC (300 infants). Univariate and multivariate analyses were performed to identify the factors influencing the development of NEC. A nomogram for predicting the risk of NEC was established based on the factors. The receiver operator characteristic (ROC) curve and the index of concordance (C-index) were used to evaluate the predictive performance of the nomogram. Results The multivariate logistic regression analysis showed that grade ≥2 intracranial hemorrhage, peripherally inserted central catheterization, breast milk fortifier, transfusion of red cell suspension, hematocrit >49.65%, mean corpuscular volume >114.35 fL, and mean platelet volume >10.95 fL were independent risk factors for NEC (P<0.05), while the use of pulmonary surfactant, the use of probiotics, and the platelet distribution width >11.8 fL were protective factors against NEC (P<0.05). The nomogram showed good accuracy in predicting the risk of NEC, with a bootstrap-corrected C-index of 0.844. The nomogram had an optimal cutoff value of 171.02 in predicting the presence or absence of NEC, with a sensitivity of 74.7% and a specificity of 80.5%. Conclusions The prediction nomogram for the risk of NEC has a certain clinical value in early prediction, targeted prevention, and early intervention of NEC.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	WANG You-Ping
	ZHENG Mei-Yu
	XIAO Ye-Ying
	QU Yang-Ming
	WU Hui

Key words： Necrotizing enterocolitis Prediction Risk factor Risk score Preterm infant

Received: 15 September 2021

Cite this article:

WANG You-Ping,ZHENG Mei-Yu,XIAO Ye-Ying et al. Risk factors for necrotizing enterocolitis and establishment of prediction model of necrotizing enterocolitis in preterm infants[J]. CJCP, 2022, 24(1): 41-48.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2109086 OR http://www.zgddek.com/EN/Y2022/V24/I1/41

	1 冉云, 文剑波. 新生儿坏死性小肠结肠炎的发病机制及防治进展[J]. 赣南医学院学报, 2020, 40(6): 611-615. DOI: 10.3969/j.issn.1001-5779.2020.06.016.
	Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis—a systematic review[J]. J Pediatr, 2020, 220: 86-92.e3. PMID: 31982088. DOI: 10.1016/j.jpeds.2019.11.011.
	3 陈超. 新生儿坏死性小肠结肠炎的临床问题及防治策略[J]. 中华儿科杂志, 2013, 51(5): 321-325. DOI: 10.3760/cma.j.issn.0578-1310.2013.05.001.
	4 范文婷, 廖伟. 新生儿坏死性小肠结肠炎发生的主要危险因素及手术时机对预后影响的回顾性分析[J]. 川北医学院学报, 2019, 34(6): 679-682. DOI: 10.3969/j.issn.1005-3697.2019.06.06.
	5 蔡岳鞠, 瞿柳红, 李薇, 等. 新生儿坏死性小肠结肠炎临床特点及预后不良危险因素多中心研究[J]. 中华实用儿科临床杂志, 2019, 34(1): 24-29. DOI: 10.3760/cma.j.issn.2095-428X.2019.01.006.
	Eaton S, Rees CM, Hall NJ. Current research on the epidemiology, pathogenesis, and management of necrotizing enterocolitis[J]. Neonatology, 2017, 111(4): 423-430. PMID: 28538238. DOI: 10.1159/000458462.
	Xiong T, Maheshwari A, Neu J, et al. An overview of systematic reviews of randomized-controlled trials for preventing necrotizing enterocolitis in preterm infants[J]. Neonatology, 2020, 117(1): 46-56. PMID: 31838477. DOI: 10.1159/000504371.
	Lin HJ, Mao SS, Shi LP, et al. Clinical characteristic comparison of low birth weight and very low birth weight preterm infants with neonatal necrotizing enterocolitis: a single tertiary center experience from eastern China[J]. Pediatr Surg Int, 2018, 34(11): 1201-1207. PMID: 30128701. DOI: 10.1007/s00383-018-4339-9.
	Maheshwari A, Patel RM, Christensen RD. Anemia, red blood cell transfusions, and necrotizing enterocolitis[J]. Semin Pediatr Surg, 2018, 27(1): 47-51. PMID: 29275817. PMCID: PMC5776697. DOI: 10.1053/j.sempedsurg.2017.11.009.
	Tei?erskas J, Barta?ien? R, Tamelien? R. Associations between red blood cell transfusions and necrotizing enterocolitis in very low birth weight infants: ten-year data of a tertiary neonatal unit[J]. Medicina (Kaunas), 2019, 55(1): 16. PMID: 30650594. PMCID: PMC6359099. DOI: 10.3390/medicina55010016.
	Rose AT, Saroha V, Patel RM. Transfusion-related gut injury and necrotizing enterocolitis[J]. Clin Perinatol, 2020, 47(2): 399-412. PMID: 32439119. PMCID: PMC7245583. DOI: 10.1016/j.clp.2020.02.002.
	Raba AA, O'Sullivan A, Semberova J, et al. Are antibiotics a risk factor for the development of necrotizing enterocolitis-case-control retrospective study[J]. Eur J Pediatr, 2019, 178(6): 923-928. PMID: 30949889. DOI: 10.1007/s00431-019-03373-0.
	Berkhout DJC, Klaassen P, Niemarkt HJ, et al. Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study[J]. Neonatology, 2018, 114(3): 277-284. PMID: 29996136. DOI: 10.1159/000489677.
	14 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
	中国医师协会新生儿科医师分会循证专业委员会. 新生儿坏死性小肠结肠炎临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2021, 23(1): 1-11. PMID: 33476530. PMCID: PMC7818154. DOI: 10.7499/j.issn.1008-8830.2011145.
	Singh R, Shah BL, Frantz ID. Necrotizing enterocolitis and the role of anemia of prematurity[J]. Semin Perinatol, 2012, 36(4): 277-282. PMID: 22818548. DOI: 10.1053/j.semperi.2012.04.008.
	Alganabi M, Lee C, Bindi E, et al. Recent advances in understanding necrotizing enterocolitis[J]. F1000Res, 2019, 8: F1000 Faculty Rev-107. PMID: 30740215. PMCID: PMC6348433. DOI: 10.12688/f1000research.17228.1.
	18 周波, 唐军. 新生儿坏死性小肠结肠炎相关研究现状[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(2): 125-132. DOI: 10.3877/cma.j.issn.1673-5250.2018.02.001.
	Nolan LS, Parks OB, Good M. A review of the immunomodulating components of maternal breast milk and protection against necrotizing enterocolitis[J]. Nutrients, 2019, 12(1): 14. PMID: 31861718. PMCID: PMC7019368. DOI: 10.3390/nu12010014.
	Zhu XL, Tang XG, Qu F, et al. Bifidobacterium may benefit the prevention of necrotizing enterocolitis in preterm infants: a systematic review and meta-analysis[J]. Int J Surg, 2019, 61: 17-25. PMID: 30500473. DOI: 10.1016/j.ijsu.2018.11.026.
	Morgan RL, Preidis GA, Kashyap PC, et al. Probiotics reduce mortality and morbidity in preterm, low-birth-weight infants: a systematic review and network meta-analysis of randomized trials[J]. Gastroenterology, 2020, 159(2): 467-480. PMID: 32592699. PMCID: PMC8014956. DOI: 10.1053/j.gastro.2020.05.096.
	Crabtree CS, Pakvasa M, Radmacher PG, et al. Retrospective case-control study of necrotizing enterocolitis and packed red blood cell transfusions in very low birth weight infants[J]. J Neonatal Perinatal Med, 2018, 11(4): 365-370. PMID: 30149467. DOI: 10.3233/NPM-1634.
	Cekmez F, Tanju IA, Canpolat FE, et al. Mean platelet volume in very preterm infants: a predictor of morbidities?[J]. Eur Rev Med Pharmacol Sci, 2013, 17(1): 134-137. PMID: 23329535.
	Catal F, Tayman C, Tonbul A, et al. Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants[J]. Clin Lab, 2014, 60(7): 1193-1200. PMID: 25134389. DOI: 10.7754/clin.lab.2013.130501.
	Go H, Ohto H, Nollet KE, et al. Using platelet parameters to anticipate morbidity and mortality among preterm neonates: a retrospective study[J]. Front Pediatr, 2020, 8: 90. PMID: 32232019. PMCID: PMC7082741. DOI: 10.3389/fped.2020.00090.
	王又平, 冯晋楠, 李振宇, 等. 不同胎龄早产儿生后24 h内血小板及相关参数参考范围[J]. 中国当代儿科杂志, 2020, 22(7): 696-700. PMID: 32669163. PMCID: PMC7389608. DOI: 10.7499/j.issn.1008-8830.2001036.
	27 刘延霞, 林则彬, 何波, 等. 个性化预测新生儿坏死性小肠结肠炎发病风险的列线图模型构建[J]. 中国儿童保健杂志, 2021, 29(8): 838-842. DOI: 10.11852/zgetbjzz2020-1901.