极早产儿输血相关性坏死性小肠结肠炎危险因素分析
Risk factors of transfusion-associated necrotizing enterocolitis in very preterm infants
Received date: 2021-09-29
Online published: 2022-08-26
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
位乐乐 , 宋娟 , 董会敏 , 决珍珍 , 李文冬 , 徐发林 , 王军 . 极早产儿输血相关性坏死性小肠结肠炎危险因素分析[J]. 临床儿科杂志, 2022 , 40(9) : 666 -671 . DOI: 10.12372/jcp.2022.21e1387
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.
| [1] | Zhang D, Xie D, He N, et al. Prophylactic use of fluconazole in very premature infants[J]. Front Pediatr, 2021, 9: 726769. |
| [2] | Agakidou E, Agakidis C, Gika H, et al. Emerging biomarkers for prediction and early diagnosis of necrotizing enterocolitis in the era of metabolomics and proteomics[J]. Front Pediatr, 2020, 8: 602255. |
| [3] | Howarth C, Banerjee J, Aladangady N. Red blood cell transfusion in preterm infants: current evidence and controversies[J]. Neonatology, 2018, 114(1): 7-16. |
| [4] | Paul DA, Mackley A, Novitsky A, et al. Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants[J]. Pediatrics, 2011, 127(4): 635-641. |
| [5] | 杨海峰, 丁颖, 曹传顶, 等. 双胎配对早产儿坏死性小肠结肠炎发生危险因素分析[J]. 临床儿科杂志, 2019, 37(8): 561-565. |
| [6] | Teišerskas J, Bartašienė R, Tamelienė 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. |
| [7] | Mohankumar K, Namachivayam K, Song T, et al. A murine neonatal model of necrotizing enterocolitis caused by anemia and red blood cell transfusions[J]. Nat Commun, 2019, 10(1): 1-17. |
| [8] | Song J, Dong H, Xu F, et al. The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates[J] PLoS One, 2021, 16(7): e0254810. |
| [9] | Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: a meta-analysis of observational data[J]. Pediatrics, 2012, 129(3): 529-540. |
| [10] | Bowker RM, Yan X, De Plaen IG. Intestinal microcirculation and necrotizing enterocolitis: The vascular endothelial growth factor system[J]. Semin Fetal Neonatal Med, 2018, 23(6): 411-415. |
| [11] | Martini S, Spada C, Aceti A, et al. Red blood cell transfusions alter splanchnic oxygenation response to enteral feeding in preterm infants: an observational pilot study[J]. Transfusion, 2020, 60(8): 1669-1675. |
| [12] | Krimmel GA, Baker R, Yanowitz TD. Blood transfusion alters the superior mesenteric artery blood flow velocity response to feeding in premature infants[J]. Am J Perinatol, 2009, 26(2): 99-105. |
| [13] | Nowicki PT. Ischemia and necrotizing enterocolitis: Where, when, and how[J]. Semin Pediatr Surg, 2005, 14(3): 152-158. |
| [14] | Koike Y, Li B, Ganji N, et al. Remote ischemic conditioning counteracts the intestinal damage of necrotizing enterocolitis by improving intestinal microcirculation[J]. Nat Commun, 2020, 11(1): 4950. |
| [15] | Zwemer CF, Davenport RD, Gomez-Espina J, et al. Packed red blood cells are an abundant and proximate potential source of nitric oxide synthase inhibition[J]. PLoS One, 2015, 10(3): e0119991. |
| [16] | Niño DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(10): 590-600. |
| [17] | Crawford TM, Andersen CC, Stark MJ. Effect of repeat transfusion exposure on plasma cytokine and markers of endothelial activation in the extremely preterm neonate[J]. Transfusion, 2020, 60(10): 2217-2224. |
| [18] | 朱君丽, 朱旭光, 马丽媛, 等. 新生儿坏死性小肠结肠炎相关因素分析与预防对策[J]. 中国预防医学杂志, 2020, 21(9): 990-994. |
| [19] | 许景林, 童小梅, 王瑞泉, 等. 极低出生体质量儿胎粪钙卫蛋白水平及影响因素分析[J]. 临床儿科杂志, 2021, 39(2):138-141. |
| [20] | Byun J, Han JW, Youn JK, et al. Risk factors of meconium-related ileus in very low birth weight infants: patients-control study[J]. Sci Rep, 2020, 10(1): 4674. |
| [21] | Heymans C, de Lange IH, Lenaerts K, et al. Chorio-amnionitis induces enteric nervous system injury: effects of timing and inflammation in the ovine fetus[J]. Mol Med, 2020, 26(1): 82. |
| [22] | Duci M, Frigo AC, Visentin S, et al. Maternal and placental risk factors associated with the development of necrotizing enterocolitis (NEC) and its severity[J]. J Pediatr Surg, 2019, 54(10):2099-2102. |
| [23] | 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. |
| [24] | 刘利九, 杨学梅, 李宇宁. 新生儿输血相关性坏死性小肠结肠炎危险因素分析[J]. 中国小儿急救医学, 2020(2): 134-138. |
| [25] | Jasani B, Rao S, Patole S. Withholding feeds and transfusion-associated necrotizing enterocolitis in preterm infants: a systematic review[J]. Adv Nutr, 2017, 8(5): 764-769. |
| [26] | Viswanathan S, Jadcherla S. Transitioning from gavage to full oral feeds in premature infants: When should we discontinue the nasogastric tube ?[J]. J Perinatol, 2019, 39(9): 1257-1262. |
| [27] | Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants[J]. Cochrane Database Syst Rev, 2016, 10(10): CD001071. |
| [28] | Gerges A, Gelfer P, Kennedy K. Randomized trial of earlier versus later oral feeding in very premature infants[J]. J Perinatol, 2018, 38(6): 687-692. |
| [29] | Dumpa V, Kamity R, Ferrara L, et al. The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants[J]. J Perinatol, 2020, 40(6): 909-915. |
| [30] | Bellodas Sanchez J, Kadrofske M. Necrotizing enterocolitis[J]. Neurogastroenterol Motil, 2019, 31(3): e13569. |
| [31] | Thompson AM, Bizzarro MJ. Necrotizing enterocolitis in newborns: pathogenesis, prevention and management[J]. Drugs, 2008, 68(9): 1227-1238. |
| [32] | Ghomi H, Yadegari F, Soleimani F, et al. The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial[J]. Int J Pediatr Otorhinolaryngol, 2019, 120: 202-209. |
| [33] | Arthur CM, Nalbant D, Feldman HA, et al. Anemia induces gut inflammation and injury in an animal model of preterm infants[J]. Transfusion, 2019, 59(4): 1233-1245. |
| [34] | 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. |
| [35] | Wang Y, Song J, Sun H, et al. Erythropoietin prevents necrotizing enterocolitis in very preterm infants: a randomized controlled trial[J]. J Transl Med, 2020, 18(1): 308. |
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