Objective To systematically evaluate the risk factors for necrotizing enterocolitis (NEC) in preterm infants. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched for case-control studies and cohort studies on the risk factors for NEC in preterm infants published up to December 2021. RevMan 5.3 software was used to perform the Meta analysis. Results A total of 38 studies were included (28 case-control studies and 10 cohort studies). The Meta analysis showed that maternal gestational diabetes (OR=2.96, P<0.001), intrahepatic cholestasis during pregnancy (OR=2.53, P<0.001), preeclampsia (OR=1.73, P=0.020), history of neonatal asphyxia (OR=2.13, P<0.001), low gestational age (OR=1.23, P=0.010), sepsis (OR=5.32, P<0.001), patent ductus arteriosus (OR=1.57, P=0.001), congenital heart disease (OR=3.78, P<0.001), mechanical ventilation (OR=2.23, P=0.020), history of antibiotic use (OR=1.07, P<0.001), use of vasopressors (OR=2.34, P=0.040), and fasting (OR=1.08, P<0.001) were risk factors for NEC in preterm infants, while cesarean section (OR=0.73, P=0.004), use of pulmonary surfactant (OR=0.43, P=0.008), and breastfeeding (OR=0.24, P=0.020) were protective factors against NEC. Conclusions Maternal gestational diabetes, intrahepatic cholestasis during pregnancy, preeclampsia, low gestational age, fasting, sepsis, patent ductus arteriosus, congenital heart disease, and histories of asphyxia, mechanical ventilation, antibiotic use, and use of vasopressors may increase the risk of NEC in preterm infants, while cesarean section, use of pulmonary surfactant, and breastfeeding may decrease the risk of NEC in preterm infants.
Key words
Necrotizing enterocolitis /
Risk factor /
Meta analysis /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 王瑞娟, 孔祥永, 蔡娜, 等. 早产儿坏死性小肠结肠炎围产高危因素的病例对照研究[J]. 中国当代儿科杂志, 2014, 16(4): 414-417. PMID: 24750842. DOI: 10.7499/j.issn.1008-8830.2014.04.022.
2 Hull MA, Fisher JG, Gutierrez IM, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study[J]. J Am Coll Surg, 2014, 218(6): 1148-1155. PMID: 24468227. DOI: 10.1016/j.jamcollsurg.2013.11.015.
3 Lin H, Mao S, Shi L, 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.
4 陈丹, 黄西林, 李小萍. 新生儿坏死性小肠结肠炎危险因素的Meta分析[J]. 中华临床医师杂志(电子版), 2010, 4(5): 563-567. DOI: 10.3969/cma.j.issn.1674-0785.2010.05.007.
5 李文艳, 刘曙东. 新生儿坏死性小肠结肠炎危险因素的Meta分析[J]. 医药前沿, 2020, 10(13): 108-110.
6 刘婧, 余加林. 足月儿与早产儿坏死性小肠结肠炎临床特征及危险因素分析[J]. 儿科药学杂志, 2021, 27(3): 14-17. DOI: 10.13407/j.cnki.jpp.1672-108X.2021.03.004.
7 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. PMID: 20652370. DOI: 10.1007/s10654-010-9491-z.
8 杨玲蓉, 李桦, 张彤, 等. 维生素D缺乏与早产儿坏死性小肠结肠炎的相关性[J]. 中国当代儿科杂志, 2018, 20(3): 178-183. PMID: 29530115. PMCID: PMC7389789. DOI: 10.7499/j.issn.1008-8830.2018.03.003.
9 朱梅英, 顾敏贞. 极低出生体重儿坏死性小肠结肠炎发生率和高危因素分析[J]. 中国新生儿科杂志, 2012, 27(2): 78-81. DOI: 10.3969/j.issn.1673-6710.2012.02.002.
10 曾森焱, 邓春. 极低出生体质量儿坏死性小肠结肠炎危险因素分析[J]. 重庆医科大学学报, 2021, 46(3): 335-340. DOI: 10.13406/j.cnki.cyxb.002644.
11 程舒鹏, 芦起, 周敏, 等. 胎龄小于34周早产儿坏死性小肠结肠炎危险因素的病例对照研究[J]. 中国循证儿科杂志, 2016, 11(2): 122-125. DOI: 10.3969/j.issn.1673-5501.2016.02.008.
12 邓香. 早产儿坏死性小肠结肠炎的危险因素分析[J]. 中国社区医师, 2017, 33(29): 35-36. DOI: 10.3969/j.issn.1007-614x.2017.29.19.
13 董会敏, 宋娟, 王永, 等. 极早早产儿坏死性小肠结肠炎的临床特征与危险因素分析[J]. 中国儿童保健杂志, 2021, 29(9): 1012-1016. DOI: 10.11852/zgetbjzz2021-0000.
14 李新华. 早产儿坏死性小肠结肠炎的临床特征及影响因素分析[J]. 中国妇幼保健, 2019, 34(24): 5673-5675. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.24.37.
15 卢浩, 周海云, 何裕滨. 早产新生儿坏死性小肠结肠炎的危险因素分析[J]. 右江医学, 2018, 46(1): 79-82. DOI: 10.3969/j.issn.1003-1383.2018.01.021.
16 马小江, 郑彤彤. 孕前及孕早期母体风险因素与早产儿坏死性小肠结肠炎的相关性研究[J]. 世界华人消化杂志, 2021, 29(10): 557-562. DOI: 10.11569/wcjd.v29.i10.557.
17 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.
18 Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis[J]. J Pediatr, 2011, 159(3): 392-397. PMID: 21489560. PMCID: PMC3137655. DOI: 10.1016/j.jpeds.2011.02.035.
19 Cotten CM, Taylor S, Stoll B, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants[J]. Pediatrics, 2009, 123(1): 58-66. PMID: 19117861. PMCID: PMC2760222. DOI: 10.1542/peds.2007-3423.
20 Bashiri A, Zmora E, Sheiner E, et al. Maternal hypertensive disorders are an independent risk factor for the development of necrotizing enterocolitis in very low birth weight infants[J]. Fetal Diagn Ther, 2003, 18(6): 404-407. PMID: 14564109. DOI: 10.1159/000073132.
21 Bertino E, Giuliani F, Prandi G, et al. Necrotizing enterocolitis: risk factor analysis and role of gastric residuals in very low birth weight infants[J]. J Pediatr Gastroenterol Nutr, 2009, 48(4): 437-442. PMID: 19330932. DOI: 10.1097/mpg.0b013e31817b6dbe.
22 Cetinkaya M, Ozkan H, Koksal N. Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants[J]. Early Hum Dev, 2012, 88(11): 893-898. PMID: 22831636. DOI: 10.1016/j.earlhumdev.2012.07.004.
23 Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study[J]. J Pediatr Gastroenterol Nutr, 2005, 40(2): 184-188. PMID: 15699694. DOI: 10.1097/00005176-200502000-00019.
24 Elabiad MT, Harsono M, Talati AJ, et al. Effect of birth weight on the association between necrotising enterocolitis and red blood cell transfusions in ≤1 500 g infants[J]. BMJ Open, 2013, 3(11): e003823. PMID: 24285632. PMCID: PMC3845042. DOI: 10.1136/bmjopen-2013-003823.
25 Gagliardi L, Bellù R, Cardilli V, et al. Necrotising enterocolitis in very low birth weight infants in Italy: incidence and non-nutritional risk factors[J]. J Pediatr Gastroenterol Nutr, 2008, 47(2): 206-210. PMID: 18664876. DOI: 10.1097/MPG.0b013e318174e855.
26 Ghidini A, Espada RA, Spong CY. Does exposure to magnesium sulfate in utero decrease the risk of necrotizing enterocolitis in premature infants?[J]. Acta Obstet Gynecol Scand, 2001, 80(2): 126-129. PMID: 11167206.
27 Josephson CD, Wesolowski A, Bao G, et al. Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants?[J]. J Pediatr, 2010, 157(6): 972-978.e1-e3. PMID: 20650470. PMCID: PMC4425198. DOI: 10.1016/j.jpeds.2010.05.054.
28 Kirtsman M, Yoon EW, Ojah C, et al. Nil-per-os days and necrotizing enterocolitis in extremely preterm infants[J]. Am J Perinatol, 2015, 32(8): 785-794. PMID: 25545445. DOI: 10.1055/s-0034-1396687.
29 Lee JY, Park KH, Kim A, et al. Maternal and placental risk factors for developing necrotizing enterocolitis in very preterm infants[J]. Pediatr Neonatol, 2017, 58(1): 57-62. PMID: 27328638. DOI: 10.1016/j.pedneo.2016.01.005.
30 Wan-Huen P, Bateman D, Shapiro DM, et al. Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants[J]. J Perinatol, 2013, 33(10): 786-790. PMID: 23702619. DOI: 10.1038/jp.2013.60.
31 Battersby C, Longford N, Mandalia S, et al. Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study[J]. Lancet Gastroenterol Hepatol, 2017, 2(1): 43-51. PMID: 28404014. DOI: 10.1016/S2468-1253(16)30117-0.
32 Cox C, Hashem NG, Tebbs J, et al. Evaluation of caffeine and the development of necrotizing enterocolitis[J]. J Neonatal Perinatal Med, 2015, 8(4): 339-347. PMID: 26757002. DOI: 10.3233/NPM-15814059.
33 Ba?os-Peláez M, Avila-Sosa V, Fernández-Carrocera LA, et al. Estimating neonatal necrotizing enterocolitis based on feeding practices[J]. Children (Basel), 2021, 8(4): 253. PMID: 33804829. PMCID: PMC8063799. DOI: 10.3390/children8040253.
34 Patel AK, Lazar DA, Burrin DG, et al. Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2014, 15(8): 735-741. PMID: 25068253. DOI: 10.1097/PCC.0000000000000211.
35 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.
36 Guthrie SO, Gordon PV, Thomas V, et al. Necrotizing enterocolitis among neonates in the United States[J]. J Perinatol, 2003, 23(4): 278-285. PMID: 12774133. DOI: 10.1038/sj.jp.7210892.
37 Bak SY, Lee S, Park JH, et al. Analysis of the association between necrotizing enterocolitis and transfusion of red blood cell in very low birth weight preterm infants[J]. Korean J Pediatr, 2013, 56(3): 112-115. PMID: 23559972. PMCID: PMC3611044. DOI: 10.3345/kjp.2013.56.3.112.
38 Chen S, Wang XQ, Hu XY, et al. Meconium-stained amniotic fluid as a risk factor for necrotizing enterocolitis in very low-birth weight preterm infants: a retrospective cohort study[J]. J Matern Fetal Neonatal Med, 2020, 33(24): 4102-4107. PMID: 30885024. DOI: 10.1080/14767058.2019.1597045.
39 Zvizdic Z, Milisic E, Jonuzi A, et al. The effects of ranitidine treatment on the risk of necrotizing enterocolitis in preterm infants: a case-control study[J]. Acta Medica (Hradec Kralove), 2021, 64(1): 8-14. PMID: 33855953. DOI: 10.14712/18059694.2021.2.
40 AlFaleh K, Al-Jebreen A, Baqays A, et al. Association of packed red blood cell transfusion and necrotizing enterocolitis in very low birth weight infants[J]. J Neonatal Perinatal Med, 2014, 7(3): 193-198. PMID: 25318632. DOI: 10.3233/NPM-14814048.
41 Wallenstein MB, Arain YH, Birnie KL, et al. Red blood cell transfusion is not associated with necrotizing enterocolitis: a review of consecutive transfusions in a tertiary neonatal intensive care unit[J]. J Pediatr, 2014, 165(4): 678-682. PMID: 25039042. PMCID: PMC4845907. DOI: 10.1016/j.jpeds.2014.06.012.
42 Sharma R, Kraemer DF, Torrazza RM, et al. Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants[J]. J Perinatol, 2014, 34(11): 858-862. PMID: 25144159. PMCID: PMC4584142. DOI: 10.1038/jp.2014.59.
43 Singh R, Visintainer PF, Frantz ID, et al. Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants[J]. J Perinatol, 2011, 31(3): 176-182. PMID: 21273983. PMCID: PMC3234132. DOI: 10.1038/jp.2010.145.
44 Parilla BV, Grobman WA, Holtzman RB, et al. Indomethacin tocolysis and risk of necrotizing enterocolitis[J]. Obstet Gynecol, 2000, 96(1): 120-123. PMID: 10862854. DOI: 10.1016/s0029-7844(00)00846-2.
45 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.
46 徐良银, 林振浪. 早产儿坏死性小肠结肠炎危险因素分析及益生菌预防效果观察[J]. 中国妇幼保健, 2018, 33(22): 5150-5153. DOI: 10.7620/zgfybj.j.issn.1001-4411.2018.22.33.
47 Yang CC, Tang PL, Liu PY, et al. Maternal pregnancy-induced hypertension increases subsequent neonatal necrotizing enterocolitis risk: a nationwide population-based retrospective cohort study in Taiwan[J]. Medicine (Baltimore), 2018, 97(31): e11739. PMID: 30075587. PMCID: PMC6081060. DOI: 10.1097/MD.0000000000011739.
48 甘馨, 毛健, 李娟. 新生儿坏死性小肠结肠炎的临床特点与结局分析[J]. 中国当代儿科杂志, 2019, 21(10): 1028-1032. PMID: 31642439. PMCID: PMC7389726. DOI: 10.7499/j.issn.1008-8830.2019.10.014.
PDF(946 KB)
