临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (9): 666-671.doi: 10.12372/jcp.2022.21e1387

• 新生儿疾病专栏 • 上一篇    下一篇

极早产儿输血相关性坏死性小肠结肠炎危险因素分析

位乐乐, 宋娟(), 董会敏, 决珍珍, 李文冬, 徐发林, 王军   

  1. 郑州大学第三附属医院新生儿科 河南省小儿脑损伤重点实验室 河南省儿科疾病临床医学研究中心(河南郑州 450052
  • 收稿日期:2021-09-29 出版日期:2022-09-15 发布日期:2022-08-26
  • 通讯作者: 宋娟 E-mail:songjuanzzu@163.com

Risk factors of transfusion-associated necrotizing enterocolitis in very preterm infants

WEI Lele, SONG Juan(), DONG Huimin, JUE Zhenzhen, LI Wendong, XU Falin, WANG Jun   

  1. Department of Neonatology, Third Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Zhengzhou 450052, Henan, China
  • Received:2021-09-29 Online:2022-09-15 Published:2022-08-26
  • Contact: SONG Juan E-mail:songjuanzzu@163.com

摘要:

目的 探讨极早产儿发生输血相关性坏死性小肠结肠炎(TA-NEC)的危险因素。方法 选择2013年4月至2021年4月新生儿重症监护室收治的接受输注红细胞的极早产儿为研究对象。符合TA-NEC组纳入标准的极早产儿为TA-NEC组;按1:2比例匹配同期同性别、胎龄(±3d)、出生体重(±200g)、输血日龄(±3d)的非NEC极早产儿作为对照组。比较两组间临床特点差异,探讨TA-NEC发生的危险因素。结果 共纳入204例极早产儿,男138例、女66例,平均胎龄(29.0±1.5)周,中位出生体重1 100.0(951.0~1 200.0)g。TA-NEC组68例,对照组136例。多因素条件logistic回归分析结果显示,宫内窘迫、绒毛膜羊膜炎、晚发型败血症是极早产儿发生TA-NEC的独立危险因素(P<0.05),完全经口喂养是其独立保护因素(P<0.05)。结论 患有宫内窘迫、绒毛膜羊膜炎和/或晚发型败血症的极早产儿在输注红细胞后48 h内更容易发生NEC。预防围生期缺氧和败血症,在安全前提下完成到完全经口喂养的过渡,对降低极早产儿TA-NEC的发生率有积极作用。

关键词: 输血相关性坏死性小肠结肠炎, 危险因素, 极早产儿

Abstract:

Objective To identify the risk factors of transfusion-associated necrotizing enterocolitis (TA-NEC) in very preterm infants. Methods The very premature infants admitted to the neonatal intensive care unit between April 2013 and April 2021 who received red blood cell transfusion were selected as the study subjects. The very premature infants meeting the inclusion criteria of the TA-NEC group were included in the TA-NEC group. Non-NEC very premature infants of the same gender, gestational age (±3 d), birth weight (±200 g) and transfusion age (±3 d) at the same time were matched as the control group at a ratio of 1∶2. The clinical characteristics between the two groups were compared to explore the risk factors of TA-NEC. Results A total of 204 very premature infants (138 boys and 66 girls) were included. The mean gestational age was (29.0±1.5) weeks, and the median birth weight was 1100.0 (951.0-1200.0) g. Sixty-eight patients were in the TA-NEC group and 136 in the control group. The multivariate conditional logistic regression analysis showed that fetal distress, chorioamnionitis and late-onset sepsis were independent risk factors of TA-NEC (P<0.05), and full oral feeding was an independent protective factor against TA-NEC (P<0.05) in very premature infants. Conclusions The very premature infants with fetal distress, chorioamnionitis and/or late-onset sepsis are more likely to develop NEC within 48hours after a transfusion of red blood cells. The prevention of perinatal hypoxia and sepsis and the completion of the transition to full oral feeding safely have a positive role in reducing the incidence of TA-NEC in very preterm infants.

Key words: transfusion-associated necrotizing enterocolitis, risk factor, very preterm infant