坏死性小肠结肠炎早产儿术后宫外发育迟缓的单中心研究

doi:10.12372/jcp.2025.25e0152

Abstract

Abstract:

Objective This study aimed to analyze the risk factors for extrauterine growth restriction (EUGR) in premature infants with necrotizing enterocolitis (NEC) after surgery and to explore preventive measures. Methods A total of 72 premature infants with NEC who underwent surgical treatment and were hospitalized in the neonatal department from 2018 to 2024 were selected. They were divided into EUGR and non-EUGR groups based on the relationship between their weight at discharge and the average growth indicators for corrected gestational age. Results The incidence of EUGR in NEC premature infants after surgery was 65.28%, with a severe EUGR incidence of 33.33%. Univariate analysis found that birth gestational age, birth weight, 1-minute Apgar score, weight at the onset of NEC, proportion of oxygen therapy methods, length of intestine resected during surgery, duration of postoperative intravenous nutrition, and the maximum amount of amino acids in intravenous nutrition within one week after surgery were statistically significant factors associated with the occurrence of EUGR. Multivariate logistic regression analysis showed that a high 1-minute Apgar score and a larger weight at the onset of NEC were protective factors for EUGR, while a longer length of intestine resected during surgery was a risk factor for EUGR. Conclusion Clinical physicians should pay attention to premature infants with low Apgar scores at birth and low weight at the onset of NEC, reduce the length of intestine resected during surgery, strengthen perioperative nutritional assessment, and adjust nutritional support plans individually to reduce the incidence of EUGR.

Key words: extrauterine growth retardation, necrotizing enterocolitis, risk factors, preterm infants

CLC Number:

YANG Mengyuan, CHEN Yanshan, PEI Wanjun, LI Jing, DONG Huifang. A single - center study on extrauterine growth retardation in preterm infants after surgery for necrotizing enterocolitis[J].Journal of Clinical Pediatrics, 2025, 43(11): 823-829.

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References 33

[1]	Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5): 986-990.
[2]	丁国芳. 宫外生长发育迟缓与营养[J]. 中华围产医学杂志, 2012, 15(9): 521-525.
	Ding GF. Extrauterine growth retardation and nutrition[J]. Zhonghua Weichan Yixue Zazhi, 2012, 15 (9): 521-525.
[3]	El Rafei R, Maier RF, Jarreau PH, et al. Postnatal growth restriction and neurodevelopment at 5 years of age: a european extremely preterm birth cohort study[J]. Arch Dis Child Fetal Neonatal Ed, 2023, 108(5): 492-498.
[4]	Carr BD, Gadepalli SK. Does surgical management alter outcome in necrotizing enterocolitis?[J]. Clin Perinatol, 2019, 46(1): 89-100. doi: S0095-5108(18)31429-5 pmid: 30771822
[5]	新生儿坏死性小肠结肠炎临床诊疗指南(2020)[J]. 临床医学研究与实践, 2021, 6(2): 201.
	Clinical guidelines for diagnosis and treatment of neonatal necrotizing enterocolitis (2020)[J]. Linchuang Yixue Yanjiu Yu Shijian, 2021, 6 (2): 201.
[6]	Wang Y, Liu S, Lu M, et al. Neurodevelopmental outcomes of preterm with necrotizing enterocolitis: A systematic review and meta-analysis[J]. Eur J Pediatr, 2024, 183(8): 3147-3158.
[7]	赖登明, 金静宜, 钭金法. 新生儿坏死性小肠结肠炎手术后的营养管理[J]. 中国实用儿科杂志, 2024, 39(5): 325-330.
	Lai DM, Jin JY, Dou JF. Nutrition management after neonatal necrotizing enterocolitis surgery[J]. Zhongguo Shiyong Erke Zazhi, 2024, 39 (5): 325-330.
[8]	Fenton TR, Kim JH. A systematic review and meta-analysis to revise the fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13(1): 59.
[9]	李月凤, 刘方, 张敏, 等. 极低出生体重儿住院期间营养状况及发生宫外发育迟缓的危险因素[J]. 中华围产医学杂志, 2014, 17(1): 23-28.
	Li YF, Liu F, Zhang M, et al. Nutritional status and risk factors for extrauterine growth retardation in very low birth weight infants during hospitalization[J]. Zhonghua Weichan Yixue Zazhi, 2014, 17 (1): 23-28.
[10]	黄晓芳, 冯琪, 李帅军, 等. 超早产儿纵向宫外生长迟缓现状调查及预测模型的建立[J]. 中华新生儿科杂志(中英文), 2024, 39(3): 136-144.
	Huang XF, Feng Q, Li SJ, et al. Investigation of longitudinal extrauterine growth retardation in ultra-premature infants and establishment of a prediction model[J]. Zhonghua Xinsheng Erke Zazhi(Chinese and English), 2024, 39 (3): 136-144.
[11]	蓝思源, 洪莉. 早产儿宫外生长发育迟缓的研究进展[J]. 国际儿科学杂志, 2022, 49(3): 149-153.
	Lan SY, Hong L. Research progress of extrauterine growth retardation in premature infants[J]. Guoji Erkexue Zazhi, 2022, 49 (3): 149-153.
[12]	早产儿营养调查协作组. 新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J]. 中华儿科杂志, 2009, 47(1): 12-17.
	Collaborative group of preterm infant nutrition investi-gation. Multicenter survey of nutrition-related status of preterm infants in neonatal intensive care unit: a report of 974 cases[J]. Zhonghua Erke Zazhi, 2009, 47 (1): 12-17.
[13]	Sun M, Lu J, Sun M, et al. Analysis of extrauterine growth retardation and related risk factors in 132 premature infants[J]. Pak J Med Sci. 2022, 38(6): 1644-1648. doi: 10.12669/pjms.38.6.5864 pmid: 35991240
[14]	蔡岳鞠, 宋燕燕, 黄志坚, 等. 早产儿出院时宫外发育迟缓的危险因素分析[J]. 中国当代儿科杂志, 2015, 17(7): 659-662.
	Cai YJ, Song YY, Huang ZJ, et al. Analysis of risk factors for extrauterine growth retardation in premature infants upon discharge[J]. Zhongguo Dangdai Erke Zazhi, 2015, 17 (7): 659-662.
[15]	马丽丽, 袁芮, 锡洪敏, 等. 早产儿坏死性小肠结肠炎合并宫外发育迟缓临床特点及危险因素分析[J]. 中华新生儿科杂志(中英文), 2024, 39(10): 587-591.
	Ma LL, Yuan R, Xi HM, et al. Clinical characteristics and risk factors of necrotizing enterocolitis complicated with extrauterine growth retardation in premature infants[J]. Zhonghua Xinsheng Erke Zazhi (Chinese and English), 2024, 39 (10): 587-591.
[16]	Sun Y, Gao Z, Hong W, et al. Analysis of postoperative outcomes and extrauterine growth retardation in preterm infants with necrotizing enterocolitis: A retrospective study[J]. Am J Perinatol, 2024, 41(S 1): e1190-e1196.
[17]	曹祥, 韦伟, 黄晓燕, 等. 中晚期早产儿出院时宫外生长发育迟缓危险因素的分析[J]. 南京医科大学学报(自然科学版), 2019, 39(9): 1345-1349.
	Cao X, Wei W, Huang XY, et al. Analysis of risk factors for extrauterine growth retardation in middle and late preterm infants upon discharge[J]. Nanjing Yike Daxue Xuebao (Natural Science Edition), 2019, 39 (9): 1345-1349.
[18]	刘彬彬, 周梦竹, 徐倩倩, 等. 早产儿出院时宫外生长迟缓危险因素分析[J]. 中国妇幼健康研究, 2022, 33(10): 49-53.
	Liu BB, Zhou MZ, Xu QQ, et al. Analysis of risk factors for extrauterine growth retardation in premature infants upon discharge[J]. Zhongguo Fuyou Jiankang Yanjiu, 2022, 33 (10): 49-53.
[19]	Gidi NW, Goldenberg RL, Nigussie AK, et al. Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in ethiopia[J]. BMJ Paediatr Open, 2020, 4(1): e000765.
[20]	Baillat M, Pauly V, Dagau G, et al. Association of first-week nutrient intake and extrauterine growth restriction in moderately preterm infants: A regional population-based study[J]. Nutrients, 2021, 13(1): 227.
[21]	张英. 新生儿重症监护室早产儿宫外发育迟缓因素分析[D]. 皖南医学院, 2020.
	Zhang Y. Analysis of factors of extrauterine growth retardation in premature infants in neonatal intensive care unit[D]. Wannan Yixueyuan, 2020.
[22]	冯惠民. 691例34周以下早产儿出院时宫外发育迟缓的相关高危因素分析[D]. 新疆医科大学, 2021.
	Feng HM. Analysis of risk factors related to extrauterine growth retardation in 691 premature infants under 34 weeks after discharge[D]. Xinjiang Medical University, 2021.
[23]	张蓉, 林新祝, 常艳美, 等. 新生儿肠外营养管理专家共识(2025)[J]. 中国当代儿科杂志, 2025, 27(3): 247-261.
	Zhang R, Lin XZ, Chang YM, et al. Expert consensus on the management of neonatal parenteral nutrition (2025)[J]. Zhongguo Dangdai Erke Zazhi, 2025, 27 (3): 247-261.
[24]	Strømmen K, Haag A, Moltu SJ, et al. Enhanced nutrient supply to very low birth weight infants is associated with higher blood amino acid concentrations and improved growth[J]. Clin Nutr ESPEN, 2017, 18: 16-22. doi: S2405-4577(16)30284-4 pmid: 29132733
[25]	杜鹏, 康权. 新生儿坏死性小肠结肠炎(nec)术后喂养不耐受及愈后的分析[D]. 重庆医科大学, 2023.
	Du P, Kang Q. Postoperative feeding intolerance and prognosis of neonatal necrotizing enterocolitis (nec)[D]. Chongqing Yike Daxue, 2023.
[26]	Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis—a systematic review[J]. J Pediatr, 2020, 220: 86-92.
[27]	Hong CR, Han SM, Jaksic T. Surgical considerations for neonates with necrotizing enterocolitis[J]. Semin Fetal Neonatal Med, 2018, 23(6): 420-425. doi: S1744-165X(18)30099-4 pmid: 30196017
[28]	Hu M, Wu F, Fu Z, et al. Clinical characteristics and influencing factors of feeding intolerance after surgery for neonatal necrotizing enterocolitis[J]. Children, 2025, 12(2): 127.
[29]	Tefera BA, Ahmed AM, Yehualashet SS. Time to recovery from necrotizing enterocolitis and its predictors among neonates admitted to neonatal intensive care unit in bahir dar, ethiopia: a retrospective follow up study, 2022[J]. PLoS One, 2024, 19(10): e0311890.
[30]	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第5版. 北京: 人民卫生出版社, 2018.
	Shao XM, Ye HM, Qiu XS. Shiyong Xinshenger Xue[M]. 5thEdition. Beijing: People's Health Publishing House, 2018.
[31]	Zhao T, Feng HM, Caicike B, et al. Investigation into the current situation and analysis of the factors influencing extrauterine growth retardation in preterm infants[J]. Front Pediatr, 2021, 9: 643387.
[32]	吴琦, 朱奕名, 孙小凡, 等. 出生体重<1 500 g极早产儿宫外发育迟缓危险因素分析[J]. 中华新生儿科杂志(中英文), 2023, 38(3): 141-145.
	Wu Q, Zhu YM, Sun XF, et al. Analysis of risk factors for extrauterine growth retardation in extremely premature infants with birth weight < 1 500 g[J]. Zhonghua Xinsheng Erke Zazhi (Chinese and English), 2023, 38 (3): 141-145.
[33]	Gao L, Shen W, Wu F, et al. Real-time predictive model of extrauterine growth retardation in preterm infants with gestational age less than 32 weeks[J]. Sci Rep, 2024, 14(1): 12884.

因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
母亲年龄（$ \bar{x} \pm s$）/岁	32.88±4.78	31.00±5.50	t=1.44	0.154
母亲妊娠期高血压[n(%)]	5（20.00）	3（6.40）	χ²=1.84	0.175
母亲重度子痫前期[n(%)]	3（12.00）	1（2.10）	χ²=1.44	0.230
母亲妊娠期糖尿病[n(%)]	7（28.00）	9（19.10）	χ²=0.74	0.390
母亲妊娠期甲状腺功能减低[n(%)]	3（12.00）	4（8.50）	χ²=0.00	0.954
产前使用激素[n(%)]	20（80.00）	39（83.00）	χ²=0.00	1.000
剖宫产娩出[n(%)]	19（76.00）	30（63.80）	χ²=1.11	0.292
单胎[n(%)]	17（68.00）	28（59.60）	χ²=0.49	0.482
男婴[n(%)]	17(68.00)	35(74.50)	χ²=0.34	0.560
胎龄[M(P₂₅~P₇₅)]/周	31.00（28.29~34.00）	29.00（27.43~31.14）	Z=2.18	0.029
出生体重[M(P₂₅~P₇₅)]/g	1 680（1 420~2 300）	1 220（1 040~1 500）	Z=3.61	<0.001
出生时小于胎龄儿[n(%)]	0（0.00）	1（2.10）	-	1.000¹⁾
1min Apgar评分[M(P₂₅~P₇₅)]	9（8，10）	8（6，9）	Z=3.04	0.002
体重恢复至出生体重时间($\bar{x}±s$)/d	11.52±4.72	10.64±4.85	t=0.74	0.461

因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
发病时日龄[M(P₂₅~P₇₅)]/d	14.00（9.50~19.50）	17.00（8.00~24.00）	Z=1.12	0.263
发病时体重[M(P₂₅~P₇₅)]/g	1 950（1 630~2 440）	1 450（1 200~1 750）	Z=3.33	0.001
发病时HFNC及以上氧疗[n(%)]	13（52.00）	39（83.00）	χ²=7.81	0.005
是否母乳喂养[n(%)]	10（40.00）	22（46.80）	χ²=0.31	0.580
术前是否达全肠内喂养[n(%)]	5（20.00）	3（6.40）	χ²=1.84	0.175
术前24~72 h血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	118.00(100.50~138.00）	109.50（97.50~141.50）	Z=0.59	0.555
术前24~72 h白蛋白[M(P₂₅~P₇₅)]/g·L^-1	30.80(29.30~32.90)	29.75（28.03~31.88）	Z=1.19	0.235
术前1周内抗生素应用[n(%)]	13（52.00）	29（61.70）	χ²=0.63	0.427

因素	非EUGR组（n=25）	EUGR组（n=47）	统计量	P
肠穿孔[n(%)]	7（28.00）	11（23.40）	χ²=0.18	0.668
切除长度[M(P₂₅~P₇₅)]/cm	12.0（3.5~17.0）	21（18~31）	Z=3.94	<0.001
术后禁食时间[M(P₂₅~P₇₅)]/d	10（9~12）	10（8~12）	Z=0.48	0.630
术后静脉营养时间[M(P₂₅~P₇₅)]/d	18（12~27）	25（16~42）	Z=2.40	0.017
术后1周平均热卡（$\bar{x}±s$）/kcal·kg^-1·d^-1	73.52±13.89	75.57±11.90	t=0.66	0.512
术后1周平均非蛋白热能与氮的比值（$\bar{x}±s$）	159.90±19.65	154.46±20.22	t=1.10	0.277
术后1周PN氨基酸最大量[M(P₂₅~P₇₅)]/g·kg^-1·d^-1	3.1（3.0~3.5）	3.5（3.0~4.0）	Z=2.29	0.022
术后1周PN脂肪乳最大量[M(P₂₅~P₇₅)]/g·kg^-1·d^-1	3.0（3.0~3.6）	3.0（3.0~3.5）	Z=0.10	0.921
术后抗生素应用时间[M(P₂₅~P₇₅)]/d	12.0（9.0~16.5）	15（11,18）	Z=1.25	0.213
术后停止氧疗时间（$\bar{x}±s$）/d	25.33±14.73	29.03±17.42	t=0.08	0.941
术后应用白蛋白[n(%)]	23（92.00）	46（97.90）	χ²=0.32	0.570
术后输注悬浮红细胞[n(%)]	22（88.00）	46（97.90）	χ²=1.44	0.230
术后肝酶异常[n(%)]	13（52.00）	24（51.10）	χ²=0.01	0.940
术后合并胆汁淤积[n(%)]	11（44.00）	21（44.70）	χ²=0.00	0.956

因素	非EUGR组（n=25）	EUGR组（n=47）	χ²值	P
NRDS	24（96.00）	42（89.40）	0.27	0.601
败血症	2（8.00）	9（19.10）	0.82	0.364
BPD	7（28.00）	18（38.30）	0.76	0.382
ROP	4（16.00）	7（14.90）	0.00	1.000
颅内出血	3（12.00）	7（14.90）	0.00	1.000
重度脑室内出血	2（8.00）	1（2.10）	0.32	0.570
中度及以上贫血	16（64.00）	33（70.20）	0.29	0.590
低血糖	0（0.00）	2（4.30）	-	0.540¹⁾
代谢性骨病	4（16.00）	10（21.30）	0.05	0.821
布洛芬治疗的PDA	0（0.00）	4（8.50）	0.92	0.337

因素	β	S.E.	χ²值	P值	OR值	95%CI
发病时体重（每100克）	-0.223	0.106	4.423	0.035	0.800	0.650~0.985
1min Apgar评分	-0.515	0.261	3.895	0.048	0.597	0.358~0.996
术中切除肠道长度（每5厘米）	0.309	0.140	4.849	0.028	1.362	1.035~1.792

A single - center study on extrauterine growth retardation in preterm infants after surgery for necrotizing enterocolitis

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