Analysis of risk factors for death in surgical treatment for neonatal necrotizing enterocolitis

QIAN Li-dan; SUN Wen-qiang; JIN Xin-yun; ZHU Xue-ping

doi:10.19538/j.ek20250506011

Abstract：Objective To retrospectively analyze the clinical data and recent outcomes of neonates with necrotizing enterocolitis(NEC)undergoing surgical treatment,and to explore the high-risk factors for mortality in NEC patients,in order to achieve early intervention and improve their prognosis.Methods Neonates diagnosed with NEC and undergoing surgical treatment at the Neonatology Department of the Children's Hospital of Soochow University from January 1,2014 to December 31,2022 were selected as the study subjects.They were divided into a survival group and a death group according to their hospitalization outcomes.The data concerning general information,underlying diseases and complications,auxiliary examinations on the day of onset,and treatment during hospitalization were collected from the two groups.By comparing the above data,the high-risk factors for death of neonates receiving NEC surgery were analyzed.Results A total of 104 newborns who underwent NEC surgery were included,including 56 males and 48 females.Among them,80 survived(76.92％)and 24 died(23.08％).The death group was significantly lower than the survival group in terms of gestational age,birth weight,corrected gestational age at onset,and prognostic nutritional index(PNI)(P＜0.05).The time from onset of disease to operation was significantly longer in the death group than in the survival group(P＜0.05).The incidence of sepsis,shock,abdominal distension,peritonitis,white blood cell count＜4×109/L,platelet count＜50×109/L,pH＜7.35,multiple perforation,and simultaneous necrosis of the ileocolon in the death group was significantly higher than that in the survival group(P＜0.05).The death group had significantly higher levels of C-reactive protein(CRP)/albumin(ALB)ratio(CAR),neutrophil to lymphocyte ratio(NLR),lactate,and Duke abdominal X-ray score(DAAS)compared to the survival group,the difference being of statistical significance(P＜0.05).Multiple Logistic regression analysis showed that platelet count＜50×109/L,elevated CAR,multiple perforation,and simultaneous necrosis of the ileocolon are risk factors for neonatal mortality in NEC surgery.Conclusion A platelet count＜50×109/L,elevated CAR,multiple perforation,and simultaneous necrosis of the ileocolon are risk factors for neonatal mortality in NEC surgery.