预测极早产儿坏死性小肠结肠炎发生风险列线图模型的建立

doi:10.7499/j.issn.1008-8830.2202093

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Abstract Objective To investigate the risk factors for necrotizing enterocolitis (NEC) in very preterm infants and establish a nomogram model for predicting the risk of NEC. Methods A total of 752 very preterm infants who were hospitalized from January 2015 to December 2021 were enrolled as subjects, among whom 654 were born in 2015-2020 (development set) and 98 were born in 2021 (validation set). According to the presence or absence of NEC, the development set was divided into two groups: NEC (n=77) and non-NEC (n=577). A multivariate logistic regression analysis was used to investigate the independent risk factors for NEC in very preterm infants. R software was used to plot the nomogram model. The nomogram model was then validated by the data of the validation set. The receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow goodness-of-fit test, and the calibration curve were used to evaluate the performance of the nomogram model, and the clinical decision curve was used to assess the clinical practicability of the model. Results The multivariate logistic regression analysis showed that neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding were independent risk factors for NEC in very preterm infants (P<0.05). The ROC curve of the development set had an area under the curve (AUC) of 0.833 (95%CI: 0.715-0.952), and the ROC curve of the validation set had an AUC of 0.826 (95%CI: 0.797-0.862), suggesting that the nomogram model had a good discriminatory ability. The calibration curve analysis and the Hosmer-Lemeshow goodness-of-fit test showed good accuracy and consistency between the predicted value of the model and the actual value. Conclusions Neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding are independent risk factors for NEC in very preterm infant. The nomogram model based on the multivariate logistic regression analysis provides a quantitative, simple, and intuitive tool for early assessment of the development of NEC in very preterm infants in clinical practice.

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	LIU Xin
	LIU Li-Jun
	JIANG Hai-Yan
	ZHAO Chang-Liang
	HE Hai-Ying

Key words： Necrotizing enterocolitis Risk factor Nomogram Very preterm infant

Received: 22 February 2022

Corresponding Authors: He H-Y，E-mail：he7004@126.com E-mail: he7004@126.com

Cite this article:

LIU Xin,LIU Li-Jun,JIANG Hai-Yan et al. Establishment of a nomogram model for predicting necrotizing enterocolitis in very preterm infants[J]. CJCP, 2022, 24(7): 778-785.

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http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2202093 OR http://www.zgddek.com/EN/Y2022/V24/I7/778

	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.
	2 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.
	Sharma R, Hudak ML. A clinical perspective of necrotizing enterocolitis: past, present, and future[J]. Clin Perinatol, 2013, 40(1): 27-51. PMID: 23415262. PMCID: PMC3575605. DOI: 10.1016/j.clp.2012.12.012.
	Jiang S, Yan W, Li S, et al. Mortality and morbidity in infants <34 weeks' gestation in 25 NICUs in China: a prospective cohort study[J]. Front Pediatr, 2020, 8: 33. PMID: 32117838. PMCID: PMC7031923. DOI: 10.3389/fped.2020.00033.
	黄兰, 熊涛, 唐军, 等. 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.
	Battersby C, Santhalingam T, Costeloe K, et al. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(2): F182-F189. PMID: 29317459. DOI: 10.1136/archdischild-2017-313880.
	Zhou J, Ba Y, Du Y, et al. The etiology of neonatal intensive care unit death in extremely low birth weight infants: a multicenter survey in China[J]. Am J Perinatol, 2021, 38(10): 1048-1105. PMID: 32102093. DOI: 10.1055/s-0040-1701611.
	8 王静, 唐莲芳, 顾美群, 等. 新生儿坏死性小肠结肠炎的危险因素及早期临床特点[J]. 昆明医科大学学报, 2021, 42(11): 99-104. DOI: 10.12259/j.issn.2095-610X.S20211118.
	9 邹耀明, 阮旭, 邓秀妹, 等. 新生儿坏死性小肠结肠炎发生的危险因素分析[J]. 现代医学与健康研究(电子版), 2021, 5(13): 110-112.
	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. PMID: 413500. PMCID: PMC1396409. DOI: 10.1097/00000658-197801000-00001.
	Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia[J]. Intern Emerg Med, 2012, 7(Suppl 3): S193-S199. PMID: 23073857. DOI: 10.1007/s11739-012-0802-0.
	Kirpalani H, Whyte RK, Andersen C, et al. The premature infants in need of transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants[J]. J Pediatr, 2006, 149(3): 301-307. PMID: 16939737. DOI: 10.1016/j.jpeds.2006.05.011.
	Bell EF, Strauss RG, Widness JA, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants[J]. Pediatrics, 2005, 115(6): 1685-1691. PMID: 15930233. PMCID: PMC2866196. DOI: 10.1542/peds.2004-1884.
	14 徐丛剑, 华克勤. 实用妇产科学[M]. 4版. 北京: 人民卫生出版社, 2018.
	Schnabl KL, Van Aerde JE, Thomson AB, et al. Necrotizing enterocolitis: a multifactorial disease with no cure[J]. World J Gastroenterol, 2008, 14(14): 2142-2161. PMID: 18407587. PMCID: PMC2703838. DOI: 10.3748/wjg.14.2142.
	Reddy NR, Krishnamurthy S, Chourasia TK, et al. Glutamate antagonism fails to reverse mitochondrial dysfunction in late phase of experimental neonatal asphyxia in rats[J]. Neurochem Int, 2011, 58(5): 582-590. PMID: 21300121. DOI: 10.1016/j.neuint.2011.01.021.
	Cotten CM. Modifiable risk factors in necrotizing enterocolitis[J]. Clin Perinatol, 2019, 46(1): 129-143. PMID: 30771814. DOI: 10.1016/j.clp.2018.10.007.
	Rose AT, Patel RM. A critical analysis of risk factors for necrotizing enterocolitis[J]. Semin Fetal Neonatal Med, 2018, 23(6): 374-379. PMID: 30115546. PMCID: PMC6269219. DOI: 10.1016/j.siny.2018.07.005.
	Unsal D, Kacan M, Temiz-Resitoglu M, et al. The role of Syk/I?B-α/NF-?B pathway activation in the reversal effect of BAY 61-3606, a selective Syk inhibitor, on hypotension and inflammation in a rat model of zymosan-induced non-septic shock[J]. Clin Exp Pharmacol Physiol, 2018, 45(2): 155-165. PMID: 28949404. DOI: 10.1111/1440-1681.12864.
	Samuels N, van de Graaf RA, de Jonge RCJ, et al. Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies[J]. BMC Pediatr, 2017, 17(1): 105. PMID: 28410573. PMCID: PMC5391569. DOI: 10.1186/s12887-017-0847-3.
	Patel RM, Knezevic A, Shenvi N, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants[J]. JAMA, 2016, 315(9): 889-897. PMID: 26934258. PMCID: PMC4805423. DOI: 10.1001/jama.2016.1204.
	Vlasova AN, Paim FC, Kandasamy S, et al. Protein malnutrition modifies innate immunity and gene expression by intestinal epithelial cells and human rotavirus infection in neonatal gnotobiotic pigs[J]. mSphere, 2017, 2(2): e00046-17. PMID: 28261667. PMCID: PMC5332602. DOI: 10.1128/mSphere.00046-17.
	Meinzen-Derr J, Poindexter B, Wrage L, et al. Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death[J]. J Perinatol, 2009, 29(1): 57-62. PMID: 18716628. PMCID: PMC2801431. DOI: 10.1038/jp.2008.117.
	李永伟, 严超英, 杨磊, 等. 母乳及配方奶喂养对NICU早产儿的影响[J]. 中国当代儿科杂志, 2017, 19(5): 572-575. PMID: 28506352. PMCID: PMC7389116. DOI: 10.7499/j.issn.1008-8830.2017.05.019.