Objective: To investigate the clinical characteristics of children with early-onset necrotizing enterocolitis (NEC) undergoing enterostomy and analyze the risk factors for postoperative complications. Methods: Retrospective analysis was conducted on the clinical data (perinatal conditions, clinical characteristics, clinical outcomes, etc.) of NEC patients who underwent enterostomy at Beijing Children's Hospital from May 2016 to May 2023. The patients were divided into two groups based on the age of onset: an early-onset enterostomy group (<14 days) and a late-onset enterostomy group (≥14 days). Furthermore, the children with NEC were categorized into complication group and non-complication group based on whether there were complications after enterostomy. The differences in clinical data between these groups were analyzed, and the clinical characteristics of children with early-onset NEC and enterostomy were summarized. Multivariate logistic regression model was employed to analyze the risk factors for postoperative complications in NEC children with enterostomy. Results: A total of 68 cases were enrolled, including 43 cases in the early-onset enterostomy group [26 males and 17 females, aged (6.5±3.0) days] and 25 cases in the late-onset enterostomy group [15 males and 10 females, aged (21.0±3.0) days]. There were 28 cases (17 males and 11 females), age [M (Q1, Q3)] 9 (5, 14) days in the complication group and 33 cases (22 males and 11 females), aged of 14 (6, 21) days in the non-complication group. Compared to the late-onset enterostomy group, the early-onset enterostomy group had significantly higher rates of intraventricular hemorrhage [30.2% (13/43) vs 8.0% (2/25)], hemodynamically significant patent ductus arteriosus [37.2% (16/43) vs 12.0% (3/25)], mechanical ventilation≥72 hours after birth [39.5% (17/43) vs 16.0% (4/25)], stage Ⅲ NEC [(69.8% (30/43) vs 40.0% (10/25)], extensive NEC [27.9% (12/43) vs 8.0% (2/25)], and short-term postoperative complications [56.8% (21/37) vs 29.2% (7/24)] (all P<0.05).Multivariate logistic regression model analysis revealed that residual length of proximal small intestine was a protective factor for postoperative complications after enterostomy in NEC infants (OR=0.764, 95%CI: 0.648-0.901, P=0.001), but stage Ⅲ NEC was a risk factor (OR=1.042, 95%CI: 1.004-5.585, P=0.017). Conclusions: The incidence of postoperative complications is high, and the prognosis is poor in children with early-onset NEC enterostomy. The residual length of proximal enterostomy is a protective factor for postoperative complications of NEC enterostomy, but stage Ⅲ NEC is a risk factor.
目的: 探讨早发型坏死性小肠结肠炎(NEC)肠造瘘患儿的临床特征,并分析术后并发症的危险因素。 方法: 回顾性分析2016年5月至2023年5月首都医科大学附属北京儿童医院收治的因NEC行肠造瘘患儿的临床资料(围产期情况、临床特征、临床结局等)。根据发病日龄不同分为早发型肠造瘘组(<14日龄)和晚发型肠造瘘组(≥14日龄);根据NEC患儿肠造瘘术后是否合并并发症,分为并发症组和无并发症组,分析各组患儿临床资料的差异,总结早发型NEC肠造瘘患儿临床特征;采用多因素logistic回归模型分析NEC肠造瘘患儿术后并发症的危险因素。 结果: 共纳入68例患儿,其中早发型肠造瘘组43例[男26例,女17例,日龄(6.5±3.0)d],晚发型肠造瘘组25例[男15例,女10例,日龄(21.0±3.0)d];NEC患儿肠造瘘术后并发症组有28例(男17例,女11例),日龄[M(Q1,Q3)]为9(5,14)d,无并发症组有33例(男22例,女11例),日龄14(6,21)d。与晚发型肠造瘘组相比,早发型肠造瘘组患儿生后合并脑室内出血[30.2%(13/43)比8.0%(2/25)]、血流动力学意义的动脉导管未闭[37.2%(16/43)比12.0%(3/25)]、生后机械通气≥72 h[39.5%(17/43)比16.0%(4/25)]、Ⅲ期NEC[69.8%(30/43)比40.0%(10/25)]及广泛型NEC[27.9%(12/43)比8.0%(2/25)]、短期术后并发症[56.8%(21/37)比29.2%(7/24)]的发生率更高,差异均有统计学意义(均P<0.05)。多因素logistic回归模型分析结果显示,造瘘近端小肠剩余长度是NEC患儿肠造瘘术后并发症的保护因素(OR=0.764,95%CI:0.648~0.901,P=0.001);而Ⅲ期NEC是其危险因素(OR=1.042,95%CI:1.004~5.585,P=0.017)。 结论: 早发型NEC肠造瘘患儿术后并发症发生率高,预后差;造瘘近端小肠剩余长度是NEC肠造瘘术后并发症的保护因素,而Ⅲ期NEC是其危险因素。.