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Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes
European Journal of Pediatric Surgery ( IF 1.8 ) Pub Date : 2022-01-10 , DOI: 10.1055/s-0041-1741544
Ceren Imren 1 , Lotte E Vlug 2 , Barbara A E de Koning 2 , Tessa Diertens 3 , Heleen E Snel 3 , Jill Suurland 4 , Renate M C Swarte 3 , Marijn J Vermeulen 3 , Claudia M G Keyzer-Dekker 1
Affiliation  

Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective.

Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children.

Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively.

Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.



中文翻译:

荷兰早产儿队列中的坏死性小肠结肠炎:患病率、死亡率和长期结果

简介 为了改善父母的咨询并指导护理策略,我们从多学科的角度研究了矫正年龄 (CA) 至 2 岁的坏死性小肠结肠炎 (NEC) 的病程和结果。

材料和方法 这是一项对早产儿(出生体重 < 1,500 g,胎龄 < 32 周)进行的回顾性队列研究,从 2008 年到 2020 年被诊断为 NEC(贝尔氏 ≥ II 期)。有关患病率、死亡率、手术、肠衰竭的数据(IF)、生长和神经发育在 2 年的随访中分别分析了药物治疗和手术治疗的儿童。

结果 3456 名早产儿中,200 名(6%)被诊断为 NEC,其中 135 名在诊断后 7 天内出现手术指征;28/135 人在手术前死亡,37/107 人在开闭手术后死亡。62 名患者进行了肠造口术,15 名患者进行了端对端吻合。描述了 77 名患者的术后过程,其中 23 名出现了手术并发症(12/23 切口疝,9/23 吻合口狭窄),13/77肠短,25/77 IF。内科 NEC 患者出生后 60 天生存率为 88%(风险比 [HR]:0.698;p  = 0.318),手术治疗的 NEC 患者为 40%(HR:3.729;p < 0.001)。在 2 年的随访中,一名患者接受了肠外营养。年龄、运动和认知发育的体重严重延迟分别见于 3%、6% 和 2%。

结论 在这个队列中,死亡率很高,尤其是在手术治疗的 NEC 患者中。手术并发症发生率与之前的研究相当,但在存活的患者中,持续的 IF 以及 2 年 CA 时生长和神经发育的严重延迟相对罕见。

更新日期:2022-01-11
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