【作者】 陈倩；

【导师】 龚小慧；

【作者基本信息】 上海交通大学 ， 儿科学（新生儿专业）， 2017， 硕士

【摘要】 背景 新生儿坏死性小肠结肠炎是新生儿期最常见的一种疾病,极低出生体重儿发生率更高,,起病凶险,病死率高,可造成严重的后遗症,迄今尚无特效的治疗方法,关于影响其发生的相关因素仍存在诸多争议。因此,需要对极低出生体重儿NEC发病的相关影响因素进行调查分析,以利于临床上进行预防和治疗。其中有很多研究报道表明母乳喂养可以明显降低NEC的发病率,2016年上海市儿童医院成立了母乳库,强化了NICU中极低I生体重儿的母乳喂养,因此,需研究证明母乳喂养为NEC发生的保护性因素,以推进母乳喂养,减少NEC的发生率。目的 分析极低出生体重儿坏死性小肠结肠炎(NEC)发生的相关影响因素如危险性因素或保护性因素,并证明母乳喂养为NEC发生的保护性因素,以推进母乳喂养。方法采用队列研究的方式对两年NICU住院的极低出生体重儿进行回顾性分析,观察组为2016年1月-2016年12月在上海交通大学附属儿童医院NICU住院的极低出生体重儿,对照组为2015年1月-2015年12月在这家医院住院的极低出生体重儿,采用病例报告表的方式收集临床资料。对两组极低出生体重儿的临床资料进行分析、总结,采用Logistic回归分析影响NEC发生的相关因素。结果(1)观察组与对照组临床资料比较:观察组极低出生体重儿NEC发生率显著低于对照组(p<0.05)。观察组极低出生体重儿的出生胎龄、出生体重、出生身长及出生头围与对照组相比较,无显著性差异,p值>0.05。观察组极低出生体重儿母乳喂养比例显著高于对照组(p值<0.05)。观察组极低出生体重儿母亲肝内胆汁淤积(ICP,0%)、其他妊娠期合并症(1.4%)均显著低于对照组(p值<0.05)。观察组极低出生体重儿合并败血症(13.0%)、肺炎(33.6%)、肺炎/休克两者同时存在(2.1%)均显著低于对照组(p值<0.05)。观察组极低出生体重儿hsPDA(15.8%)、脐静脉置管(UVC)(19.2%)均显著高于对照组(p值<0.05)。观察组极低出生体重儿应用肺表面活性物质的比例(61.6%)显著低于对照组(p值<0.05)。在疾病转归上,观察组极低出生体重儿死亡的比例(4,8%)较对照组低(p值<0.05),出院时体重增长幅度850(573,1124)g较对照组高(p值<0.05)。(2)NEC发生的影响因素分析:将母乳喂养、母亲妊娠期合并症(肝内胆汁淤积、其他)、败血症、肺炎、肺炎合并休克、hs PDA、脐静脉置管、出院时体重增长幅度等多种因素与NEC进行Logistic回归分析,结果显示:母乳喂养(p值0.03,OR值<1)为极低出生体重儿NEC发生的保护性因素,败血症(p值0.013,OR值>1)为极低出生体重儿NEC发生的危险性因素。结论母乳喂养为极低出生体重儿NEC发生的保护性因素,败血症为极低出生体重儿NEC发生的危险性因素。因此应该积极提倡极低出生体重儿母乳喂养,推动母乳库的建立,降低其NEC发病率。对于存在败血症的极低出生体重儿,需警惕NEC的发生,积极抗感染治疗。更多还原

【Abstract】 Background Neonatal necrotizing enterocolitis(NEC)is the most common disease in the neonatal period,especially in very low birth weight infants,Because of it’s quick onset and high mortality,it can cause serious complications.Nowadays there is no specific treatment.Because there are still numerous disputes on the relevant factors of necrotizing enterocolitis,it’s necessary to analyze the relevant factors of NEC in newborns for its prevention and management in the clinical There are a lot of research reports show that breastfeeding can be significantly reduced the incidence of NEC.In 2016,milk bank was founded in the shanghai children’s hospital,strengthening breastfeeding for very low birth weight infants in NICU.Therefore,we should study that breastfeeding is the protective factor for development of NEC,for promoting breastfeeding and reducing the incidence of NEC,Objective To analyze the risk or protective factors for development of NEC in very low birth weight infants and to testify that breastfeeding is the protective factor for development of NEC,for promoting breastfeeding.Methods There is a retrospective analysis on very low birth weight infants in hospital for two years,according to the way of Cohort study.The very low birth weight infants(named control group)were from neonatal intensive care units(NICU)in Children’ s Hospital Jiao tong University during January,2015 and December 2015.The very low birth weight infants(named observative group)were from NICU in Children’s Hospital Jiao tong University during January,2016 and December 2016.The clinical data were collected using case report forms and were analyzed and summarized,and the relevant factors for development of NEC were analyzed by logistic regression test.Results(1)Clinical featrures between observative group and control group:The incidence of NEC in observative group is significantly lower than that of control group(p<0.05).Birth gestational age,birth weight,birth length and head circumference are similar between the observative group and the control group(p>0.05).The rate of breastfeeding in observative group is significantly higher than that of control group(p<0.05),ICP(0%)and Other pregnancy complications(1.4%)in observative group are significantly lower than those of control group(p<0.05).With sepsis(13.0%),pneumonia(33.6%),combined with pneumonia and shock(2.1%)in observative group are significantly lower than those of control group(p<0.05).hs PDA(15.8%)and Umbilical Venous Catheters(UVC,19.2%)in observative group are significantly higher than those of control group(p<0.05).There are less very low birth weight infants receiving Pulmonary surfactant(61.6%)in observative group than in control group(p<0.05).The mortality(4.8%)in observative group is significantly lower than control group(p<0.05).The median of weight growth at discharge in observative group was 850g,which is more than that in control group(p<0.05).(2)Influencing factors analysis for development of NEC:There is a logistic regression analysis between breastfeeding,pregnancy complications(ICP,other),sepsis,pneumonia,combined with pneumonia and shock,hs PDA,UVC,weight growth at discharge and NEC.The logistic regression analysis reveals breastfeeding(p=0.03,OR<1)is the protective factor for development of NEC in very low birth weight infants whereas sepsis(p=0.013,OR>1)is the risk factor for development of NEC in very low birth weight infants.Conclusions breastfeeding is the protective factor for development of NEC in very low birth weight infants,whereas sepsis is the risk factor for development of NEC in very low birth weight infants.It is necessary to promote breastfeeding and facilitate the establishment of breast milk bank in very low birth weight infants for reducing the incidence of NEC.Meanwhile we should be observed carefully to avoid the development of NEC for the very low birth weight infants with sepsis and be positive in anti-infection treatment.更多还原