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The role of nutrition in analysis of risk factors and short-term outcomes for late-onset necrotizing enterocolitis among very preterm infants: a nationwide, multicenter study in China

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单位： [1]Department of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen 361003, Fujian, China. [2]Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China. [3]Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. [4]Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China. [5]Department of Neonatology, Guiyang Maternity and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, China. [6]Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China. [7]Department of Pediatrics, Peking University Third Hospital, Beijing 100074, China. [8]Department of Neonatology, Maternal and Children’s Hospital of Guangdong Province, Guangzhou, China. [9]Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China. [10]Department of Neonatology, Children’s Hospital of Hebei Province, Shijiazhuang, China. [11]Department of Neonatology, Children’s Hospital of Nanjing Medical University, Nanjing, China. [12]Department of Neonatology, The First Hospital of Jilin University, Changchun, China. [13]Department of Neonatology, Quanzhou Maternity and Children’s Hospital, Quanzhou, China. [14]Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [15]Department of Neonatology, Liaocheng People’s Hospital, Liaocheng, China. [16]Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, China. [17]Department of Neonatology, Suzhou Municipal Hospital, Suzhou, China. [18]Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China. [19]Department of Neonatology, School of Medicine, Chengdu Women’ and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, China.

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关键词： Very preterm infants Late-onset NEC Risk factors Breastfeeding Extrauterine growth restriction Lateonset sepsis

摘要：

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease, primarily affects preterm newborns and occurs after 7 days of life (late-onset NEC, LO-NEC). Unfortunately, over the past several decades, not much progress has been made in its treatment or prevention. This study aimed to analyze the risk factors for LO-NEC, and the impact of LO-NEC on short-term outcomes in very preterm infants (VPIs) with a focus on nutrition and different onset times.Clinical data of VPIs were retrospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. A total of 2509 enrolled VPIs were divided into 2 groups: the LO-NEC group and non-LO-NEC group. The LO-NEC group was divided into 2 subgroups based on the onset time: LO-NEC occurring between 8 ~ 14d group and LO-NEC occurring after 14d group. Clinical characteristics, nutritional status, and the short-term clinical outcomes were analyzed and compared among these groups.Compared with the non-LO-NEC group, the LO-NEC group had a higher proportion of anemia, blood transfusion, and invasive mechanical ventilation (IMV) treatments before NEC; the LO-NEC group infants had a longer fasting time, required longer duration to achieve the target total caloric intake (110 kcal/kg) and regain birthweight, and showed slower weight growth velocity; the cumulative dose of the medium-chain and long-chain triglyceride (MCT/LCT) emulsion intake in the first week after birth was higher and breastfeeding rate was lower. Additionally, similar results including a higher proportion of IMV, lower breastfeeding rate, more MCT/LCT emulsion intake, slower growth velocity were also found in the LO-NEC group occurring between 8 ~ 14d when compared to the LO-NEC group occurring after 14 d (all (P < 0.05). After adjustment for the confounding factors, high proportion of breastfeeding were identified as protective factors and long fasting time before NEC were identified as risk factors for LO-NEC; early feeding were identified as protective factors and low gestational age, grade III ~ IV neonatal respiratory distress syndrome (NRDS), high accumulation of the MCT/LCT emulsion in the first week were identified as risk factors for LO-NEC occurring between 8 ~ 14d. Logistic regression analysis showed that LO-NEC was a risk factor for late-onset sepsis, parenteral nutrition-associated cholestasis, metabolic bone disease of prematurity, and extrauterine growth retardation.Actively preventing premature birth, standardizing the treatment of grade III ~ IV NRDS, and optimizing enteral and parenteral nutrition strategies may help reduce the risk of LO-NEC, especially those occurring between 8 ~ 14d, which may further ameliorate the short-term clinical outcome of VPIs.ChiCTR1900023418 (26/05/2019).© 2024. The Author(s).

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出版当年[2023]版：

大类 | 3 区医学

小类 | 3 区儿科

最新[2025]版：

大类 | 3 区医学

小类 | 3 区儿科

JCR分区：

出版当年[2022]版：

Q2 PEDIATRICS

最新[2023]版：

Q2 PEDIATRICS

影响因子： 2 最新[2023版] 2.4 最新五年平均 2.4 出版当年[2022版] 2.9 出版当年五年平均 2.567 出版前一年[2021版] 2 出版后一年[2023版]

第一作者：

第一作者单位： [1]Department of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen 361003, Fujian, China. [2]Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China.

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通讯作者：

通讯机构： [1]Department of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen 361003, Fujian, China. [2]Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China.

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The role of nutrition in analysis of risk factors and short-term outcomes for late-onset necrotizing enterocolitis among very preterm infants: a nationwide, multicenter study in China

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