Analysis of clinical characteristics of 623 cases of neonatal necrotizing enterocolitis

Objective To investigate the incidence, mortality and clinical characteristics of neonatal necroti-zing enterocolitis(NEC) in Shanghai. Methods A retrospective study was conducted in 623 cases of NEC from January 2010 to December 2015 at Children′s Hospital of Fudan University.All analysis were performed by using the statistical software package Stata 12.0. Results Six hundred and twenty-three NEC neonates were included in the study, and 485 of them were preterm infants, including 304 cases of stage 1, 176 cases of stage 2 and 143 cases of stage 3.The gestational age was (33.2±3.9) weeks, and the birth weight was (1 979.7±813.5) g. The incidence of NEC in Children′s Hospital of Fudan University was 1.29% (410/31 662 cases), and that of the stage 2 and stage 3 was 1.01% (319/31 662 cases). The gestational age was smaller and birth weight was less in the stage 2 and stage 3 group than that in the stage 1 group (all P<0.001). The percentage of cases received breast milk feeding was 7%.The rate of prophylactic antibiotics within 3 days of their life and ibuprofen for patent ductus arteriosus prior to NEC in stage 1 group was lower than that in stage-2 and stage 3 groups (all P<0.05). The most common clinical presentations were abdominal distension(71.75%, 447/623 cases), decreased bowel sounds(56.02%, 143/623 cases), looked sick (45.43%, 283/623 cases) and bloody stools(40.45%, 252/623 cases). The bowel perforation rate of the preterm and the term infants was 17.73%(86/485 cases)and 13.04%(18/138 cases), respectively.The patients who received surgical management took up 25.36%.The neonates were most commonly complicated with post-NEC stenosis (10.27%) and a culture-proven sepsis(7.87%). The count of white blood cell (WBC)<4×109/L and platelet<100×109/L raising level in stage 2 and stage 3 were higher than those in stage 1(all P<0.05). The antibiotics used for NEC were metronidazole (69.34%), carbapenems (65.65%), cephalosporins(61.16%) and penicillins(58.59%). The prognosis of NEC showed that cure cases occupied 65.49%, discharged cases with a better condition 19.58%, and death cases occupied 14.93%.The mortality of stage 3 accounted for 45.46%. Conclusions Newborn NEC mainly had gestational age of 28-34 weeks and birth weight of 1 000-1 999 g, respectively.The incidence of NEC 1.29% and it is decreasing year by year, while that of very-low-birth weight(VLBW) is still as high as 11.82%.The mortality of NEC occupies 14.93%, while that of stage 3 reaches as high as 45.46%. Key words: Infant, newborn; Infant, premature; Necrotizing enterocolitis; Influencing factor