ПРЕДИКТОРЫ НЕКРОТИЗИРУЮЩЕГО ЭНТЕРОКОЛИТА У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ С ГЕСТАЦИОННЫМ ВОЗРАСТОМ МЕНЕЕ 32 НЕДЕЛЬ

Abstract

Necrotizing enterocolitis (NEC) is a serious gastrointestinal problem in premature newborns that can often lead to a poor outcome. Physicians’ knowledge of the earliest predictors of NEC will reduce the likelihood of its development. The purpose of the research was to seek for the earliest predictors of NEC development in the neonatal period in surviving premature newborns with the gestational age (GA) at birth of less than 32 weeks. Materials and methods used: a single-center retrospective cohort study. The analysis of 167 medical records in the Moscow Oblast Regional Perinatal Center (MOPC, located in Balashikha, Moscow Oblast, Russia) was carried out. Inclusion criteria: 1) newborns with GA of less than 32 weeks; 2) information corresponding to the primary variables of this research in the patient's medical records; 3) patients were treated during the period from Apr. 22 to Dec. 24, 2021. Exclusion criteria: 1) lethal outcome, 2) congenital malformations affecting the outcome, 3) chromosomal and/or genetic abnormalities. Two groups: G1 (“NEC”) of 35 patients with NEC; G2 (“without NEC”) of 132 without NEC. Results: NEC incidence was 8.3% (35/167). Prenatal factors that are statistically significantly more common in the NEC group: an increase in the level of C-reactive protein (CRP) in the mother's blood prior to the delivery (p=0.003), an increase in pathogenic microflora during pregnancy (p=0.010), detection of Enterococcus faecalis during pregnancy (p=0.016), delivery by the C-section (p=0.028) and the C-section due to fetal deterioration (p=0.001). In premature newborns from the NEC group, a decrease in serum albumin (SA) concentration was statistically significantly more common in the first 30 hours of life (p<0.001). The use of dexamethasone in the first 168 hours of life (p=0.003) and for the prevention of bronchopulmonary dysplasia (p=0.010) was statistically significantly more common in patients with NEC. Conclusion: the earliest prenatal predictors of NEC in surviving premature newborns with the GA at birth of less than 32 weeks are as follows: an increase in the level of CRP in the mother's blood prior to the delivery, the growth of pathogenic microflora during pregnancy, esp. of the fecal Enterococcus, the C-section, esp. due to the deterioration of the fetus; and the postnatal predictors of NEC are as follows: lower concentration of SA in premature infants in the first 30 hours of life, the use of dexamethasone in the neonatal period.