Predictive Indicators for Necrotizing Enterocolitis With the Presence of Portal Venous Gas and Outcomes of Surgical Interventions.

Xin Lin,Hui-Ping Zeng,Chang-Yi Yang,Ying-Ying Lin,Yi-Fan Fang

doi:10.3389/fped.2021.683510

Abstract

Objectives: Portal venous gas (PVG) was an important clinical sign in stage II or III necrotizing enterocolitis (NEC) in preterm neonates. Not a proper predictive indicator was found to predict the diseases (NEC with the presence of PVG) up to now. There is a need to put forward predictive indicators and compare the predictive effects among them.Methods: We conducted a retrospective study of preterm neonates with NEC-PVG (n = 61) or NEC-non PVG (n = 62) from 2014 to 2021. Predictive indicators were put forward and determined by receiver operating characteristic curve analysis. An analysis of the surgical interventions and their outcomes was performed.Results: The incidence rate of NEC among preterm neonates was 4.99%; surgical and conservative interventions accounted for 20.47 and 75.07%, and the mortality rate was 0.03%. The composition ratio of shock in the NEC-PVG group increased 13.2% (P = 0.029). C-reactive protein, fibrinogen degradation product, and blood glucose had better predictive effects in the predictive indicators (P < 0.05). Intestinal necrosis and subependymal hemorrhage in the outcomes of surgical interventions had a strong relationship with the presence of PVG in NEC II/III (P < 0.05).Conclusion: Early and reasonable use of antibiotics, improvement of coagulation function, rectification of acidosis, and decreased blood glucose could cut down the occurrence of the disease (NEC with the presence of PVG). Except for subependymal hemorrhage and intestinal necrosis, NEC with the presence of PVG did not increase the occurrence of other outcomes after surgery.

Highlights

Necrotizing enterocolitis (NEC) is a serious intestinal disease caused by the combined effects of immaturity, infection, ingestion, ischemia injury, insufficient oxygenation, and immunological factors, which threatens the life of neonates [1]
Of the mechanism of NEC [10], changes in inflammation indicators were used at the early diagnosis of infections [11, 12]; procoagulant status of coagulation function indicators was found at the start of NEC in prematurity [13]; abnormity of blood lactate concentrations in the preoperative period carries a poor prognosis in neonates with NEC [14]
The Criteria of Inclusion and Exclusion Preterm neonates diagnosed with stage II or III NEC with a gestational age (GA) of 25–36 weeks were included in neonatal intensive care unit (NICU) from January 2014 to January 2021, while neonates diagnosed with stage I were excluded

Summary

Introduction

Necrotizing enterocolitis (NEC) is a serious intestinal disease caused by the combined effects of immaturity, infection, ingestion, ischemia injury, insufficient oxygenation, and immunological factors, which threatens the life of neonates [1]. Of the mechanism of NEC [10], changes in inflammation indicators were used at the early diagnosis of infections [11, 12]; procoagulant status of coagulation function indicators was found at the start of NEC in prematurity [13]; abnormity of blood lactate concentrations in the preoperative period carries a poor prognosis in neonates with NEC [14]. Whether these can be used as the predictive indicators on the disease (NEC with the presence of PVG) is still uncertain. There is an urgent need to find predictive indicators with both high sensitivities and specificity and to compare the predictive effects among them

Objectives

Methods

Results

Conclusion