Objective Bell stage was modified by metabolic disorder score(metabolic derangement,MD)scale for retrospective analysis of the cases of premature infants with necrotizing enterocolitis(NEC)to provide the basis for improving the clinical cure rate,evaluate the operation timing and improve the prognosis of NEC in premature infants.Method A retrospective analysis method was used,clinical data of 224 premature infants admitted to NICU for NEC in our hospital from January 2019 to December 2022,according to the revised Bell stage,it is divided into ⅠB,ⅡA,ⅡB and Ⅲ.According to whether the child had surgical treatment,it was divided into the surgical group and the conservative group.According to the disease conversion,it was divided into the cured group,the poor prognosis group.The correlation of MD score and modified Bell stage,severity of NEC and timing of surgical intervention was analyzed.Results According modified Bell stage,83 in ⅠB,52 in ⅡA,47 and 42 in ⅡB,Ⅲ,165 in the conservative group,59 in the surgery group,141 in the cured group,83 in poor prognosis(79 improved and 4 deaths).Stage ⅠB was followed by conservative treatment,3 stage ⅡA operations,the difference in outcome between the conservative group and the surgical group was not statistically significant(P=1.0).21 patients of stage ⅡB were selected for surgical treatment,and the cure rate of surgical treatment was higher than that of conservative treatment,and the prognosis was statistically significant(χ2=6.300,P=0.012).There were 7 children who chose conservative treatment in stage Ⅲ,among which 4 patients died after their family members abandoned treatment,and 35 children chose surgical treatment.The cure rate in the surgical group was higher than that of the conservative group,but the prognosis difference in stage Ⅲ between the conservative group and the surgical group was not significant(χ2=1.577,P=0.209).Univariate analysis of the correlation of the variables of MD scale and NEC prognosis in preterm infants found a statistically significant in the association of acidosis,elevated procalcitonin(PCT),hyponatremia,thrombocytopenia,hypotension,and neutropenia with poor prognosis(P<0.05).Multivariate Logistic regression analysis affecting premature infant outcome of NEC showed that surgical treatment favored prognosis(β=2.844),acidosis(OR=0.076,95%CI:0.025～0.232),thrombocytopenia(OR=0.173,95%CI:0.065～0.463),surgical treatment(OR=17.178,95%CI:4.330～68.142)affected prognosis significantly(P<0.01).The difference in MD≥4 distribution in the surgical and conservative groups was statistically significant(χ2=109.895,P<0.01),the distribution of Bell stage≥stage ⅡB between the surgical and conservative groups was significant(χ2=101.859,P<0.01).Conclusion Revised Bell stage and MD score in premature NEC infants can predict poor prognosis and surgical correlation,and provide a basis for the evaluation of disease severity and the choice of surgical timing.
万方数据
维普
