Abdulrahman Almehaid, Lina Alsherbini, Mohanned Alrahili, Mohammed Almahdi, Saud Aljadaan, Omar Abbas, Norah S Alsabti, Ghiada A Almutairi, Sarah F Almujarri, Ashwag Alsubaie, Mashael Almutairi, Ahmed Alwatban, Abdulaziz Homedi, Saif Alsaif, Kamal Ali
{"title":"早产儿自发性肠穿孔和坏死性小肠结肠炎的比较结果：来自沙特阿拉伯的回顾性队列研究。","authors":"Abdulrahman Almehaid, Lina Alsherbini, Mohanned Alrahili, Mohammed Almahdi, Saud Aljadaan, Omar Abbas, Norah S Alsabti, Ghiada A Almutairi, Sarah F Almujarri, Ashwag Alsubaie, Mashael Almutairi, Ahmed Alwatban, Abdulaziz Homedi, Saif Alsaif, Kamal Ali","doi":"10.1136/bmjpo-2025-003667","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.</p><p><strong>Patients: </strong>Preterm infants born at <32 weeks' gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.</p><p><strong>Main outcome measures: </strong>Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).</p><p><strong>Results: </strong>Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).</p><p><strong>Conclusions: </strong>SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243581/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia.\",\"authors\":\"Abdulrahman Almehaid, Lina Alsherbini, Mohanned Alrahili, Mohammed Almahdi, Saud Aljadaan, Omar Abbas, Norah S Alsabti, Ghiada A Almutairi, Sarah F Almujarri, Ashwag Alsubaie, Mashael Almutairi, Ahmed Alwatban, Abdulaziz Homedi, Saif Alsaif, Kamal Ali\",\"doi\":\"10.1136/bmjpo-2025-003667\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.</p><p><strong>Patients: </strong>Preterm infants born at <32 weeks' gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.</p><p><strong>Main outcome measures: </strong>Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).</p><p><strong>Results: </strong>Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).</p><p><strong>Conclusions: </strong>SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols.</p>\",\"PeriodicalId\":9069,\"journal\":{\"name\":\"BMJ Paediatrics Open\",\"volume\":\"9 1\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-07-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243581/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Paediatrics Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjpo-2025-003667\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Paediatrics Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjpo-2025-003667","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较诊断为自发性肠穿孔（SIP）和坏死性小肠结肠炎（NEC）的早产儿的危险因素、手术处理、营养结局和短期新生儿发病率和死亡率。设计：回顾性队列研究。环境：沙特阿拉伯利雅得三级中心的三级新生儿重症监护病房。主要结局指标：临床特征、手术干预、营养结局、主要新生儿发病率和死亡率。采用多变量logistic回归确定死亡率和延长肠外营养（PN bbb60天）的独立预测因素。结果：SIP患儿的诊断时间较早(中位7天vs 20天；p60天（46% vs 24%, p=0.028）和更多的pn相关胆汁淤积（60% vs 36%, p=0.013）。放电时生长衰竭很常见（NEC 81%, SIP 73%）。重度IVH在SIP中更为常见（41%对17%，p=0.007），而需要治疗的ROP在NEC中更为常见（75%对52%，p=0.016）。死亡率的独立预测因素包括脓毒症（校正OR (aOR) 10.5, 95% CI 2.67 ~ 41.22）和低胎龄（aOR 1.35, 95% CI 1.04 ~ 1.77）。NEC诊断预测PN延长（SIP vs NEC的aOR为0.20,95% CI为0.07 ~ 0.58）。结论：SIP和NEC在发病时间、手术入路和营养轨迹上有显著差异。NEC与更大的手术复杂性和营养发病率相关。这些发现支持了针对具体情况的手术和喂养方案的发展。
Comparative outcomes of spontaneous intestinal perforation and necrotising enterocolitis in preterm infants: a retrospective cohort study from Saudi Arabia.
Objective: To compare risk factors, surgical management, nutritional outcomes and short-term neonatal morbidity and mortality between preterm infants diagnosed with spontaneous intestinal perforation (SIP) and necrotising enterocolitis (NEC).
Design: Retrospective cohort study.
Setting: Level III neonatal intensive care unit at a tertiary centre in Riyadh, Saudi Arabia.
Patients: Preterm infants born at <32 weeks' gestation diagnosed with either SIP (n=42) or NEC (n=60) between January 2016 and December 2024.
Main outcome measures: Clinical characteristics, surgical intervention, nutritional outcomes, major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent predictors of mortality and prolonged parenteral nutrition (PN >60 days).
Results: Infants with SIP were diagnosed earlier (median 7 vs 20 days; p<0.001), had lower gestational age and birth weight and more often received postnatal hydrocortisone. Peritoneal drainage was the predominant surgical approach in SIP (98% vs 45%, p<0.001), whereas infants with NEC underwent more laparotomies (67% vs 5%) and stoma formation (42% vs 0%; both p<0.001). Infants with NEC had longer PN duration (48 vs 41 days, p=0.003), higher incidence of PN >60 days (46% vs 24%, p=0.028) and more PN-associated cholestasis (60% vs 36%, p=0.013). Growth failure at discharge was common (NEC 81%, SIP 73%). Major IVH was more frequent in SIP (41% vs 17%, p=0.007), while ROP needing therapy was more common in NEC (75% vs 52%, p=0.016). Independent predictors of mortality included sepsis (Adjusted OR (aOR) 10.5, 95% CI 2.67 to 41.22) and lower gestational age (aOR 1.35, 95% CI 1.04 to 1.77). NEC diagnosis predicted prolonged PN (aOR 0.20 for SIP vs NEC, 95% CI 0.07 to 0.58).
Conclusions: SIP and NEC differ significantly in timing of onset, surgical approach and nutritional trajectory. NEC is associated with greater surgical complexity and nutritional morbidity. These findings support the development of condition-specific surgical and feeding protocols.
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