低出生体重児の新生児における壊死性腸炎の予測因子。レトロスペクティブな解析

The predictors of necrotizing enterocolitis in newborns with low birth weight: A retrospective analysis.

抄録

ABSTRACT:

低出生体重（LBW）新生児における壊死性腸炎（NEC）の影響因子を調査し、NECの臨床管理への洞察を得る必要がある。本研究は後方視的コホート研究であった。2019年1月1日から2021年6月30日までに当院に入院した乳幼児を抽出した。NEC乳児とNECでない乳児の臨床的特徴を評価した。LBW乳児のNECの危険因子を評価するためにロジスティック回帰分析を行った。合計192人のLBW乳児が含まれ、LBW乳児のNECの発生率は35.42%であった。先天性心疾患、敗血症、母乳育児、輸血、プロバイオティクス給餌はNEC群と非NEC群で有意差があった（いずれもP < .05），出生時体重，妊娠期間，母親の妊娠高血圧症候群，胎膜早期破裂，羊水汚染，胎児窒息，新生児呼吸窮迫症候群，人工呼吸はNEC群とNO-NEC群で有意差を認めなかった（いずれもP > .05）．先天性心疾患（OR：2.128，95％CI：1.103-3.511），敗血症（OR：1.630，95％CI：1.022-2.549），輸血（OR：1.451，95％CI：1.014-2.0）であった。085）がLBW児のNECの独立した危険因子であり，母乳育児（OR: 0.494, 95% CI: 0.023-0.928），probiotics feeding（OR: 0.816, 95% CI: 0.782-0.982）がLBW児のNECに対する防御因子であった．LBW児のNECの発生率は高く、多くの要因に影響されており、LBW児の予後を改善するために、危険因子と保護因子に的を絞った包括的な介入が必要である。

ABSTRACT: There are needs to investigate the influencing factors of necrotizing enterocolitis (NEC) in low birth weight (LBW) newborns, to provide insights into the clinical management of NEC.This study was a retrospective cohort study. Infants admitted to our hospital from January 1, 2019 to June 30, 2021 were selected. The clinical characteristics of NEC and no-NEC infants were evaluated. Logistic regression analyses were conducted to assess the risk factors of NEC in LBW infants.A total of 192 LBW infants were included, the incidence of NEC in LBW infants was 35.42%. There were significant differences in the congenital heart disease, sepsis, breastfeeding, blood transfusion and probiotics feeding between NEC and no-NEC group (all P < .05), and there were no significant differences in birth weight, gestational age, mother's pregnancy-induced hypertension, premature rupture of fetal membrane, amniotic fluid pollution, fetal asphyxia, neonatal respiratory distress syndrome and mechanical ventilation between NEC and no-NEC group (all P > .05). Congenital heart disease (OR: 2.128, 95% CI: 1.103-3.511), sepsis (OR: 1.630, 95% CI: 1.022-2.549), and blood transfusion (OR: 1.451, 95% CI: 1.014-2.085) were the independent risk factors for NEC in LBW infants, and breastfeeding (OR: 0.494, 95% CI: 0.023-0.928), probiotics feeding (OR: 0.816, 95% CI: 0.782-0.982) were the protective factors for the NEC in LBW infants. The prognosis of NEC infants undergone surgery treatment was better than that of infants undergone conservative treatments (P = .043).The incidence of NEC in LBW is high, which is affected by many factors, and comprehensive interventions targeted on the risk and protective factors should be made to improve the prognosis of LBW infants.