Clinical characteristics of necrotizing enterocolitis in premature twins / 中华实用儿科临床杂志

ABSTRACT

Objective:To analyze the clinical characteristics and prognosis of twin premature infants with necrotizing enterocolitis (NEC).Methods:The clinical data of twin preterm infants with NEC treated in Shengjing Hospital of China Medical University from January 2009 to December 2018 were retrospectively analyzed and compared with singleton preterm infants, thus clarifying clinical characteristics and treatment outcomes of twin preterm infants with NEC.Results:The incidence of NEC in twin premature infants was significantly higher than that in singleton premature infants [8.1% (124 /1 539 cases) vs.3.8% (497/13 198 cases), χ2=62.887, P<0.001]. The number of small twins in natural delivery group was more than that of large twins [(23 cases vs.5 cases), χ2=8.09, P<0.05]. Compared with singleton NEC preterm infants, twin NEC preterm infants had significantly lower birth weight [(1 424±439) g vs.(1 761 ± 596) g, t=-15.07, P<0.001], higher rate of mechanical ventilation after birth [37.1% (46/124 cases) vs.17.9%(89 / 497 cases), χ2=15.539, P<0.001], and higher mortality [13.7%(17/124 cases) vs.7.0%(35/497 cases), χ2=5.401, P<0.05]. Compared with singleton preterm infants with NEC, twin preterm infants with NEC had significantly higher surgical treatment rate [54.8%(68/124 cases) vs.43.9%(218/497 cases), χ2=27.885], younger operation age [(20.6 ± 17.5) d vs.(29.4 ± 24.4) d, t =-5.673], higher degrees of anemia [(118.284 ± 22.429) g/L vs.(127.460±28.352) g/L , t=-3.398], thrombocytopenia [(213.57 ± 150.548)×10 9/L vs.(220.25 ± 169.610)×10 9/L, t =-3.238], metabolic acidosis(7.215 ± 0.211 vs.7.355±0.418, t=-4.207), rate of shock [(52.9%(36/68 cases) vs.36.7%(80/218 cases), χ2= 5.673], and the rate of mechanical ventilation[54.4% (37/68 cases) vs.35.8%(78/218 cases), χ2=7.484](all P<0.05). Extensive intestinal necrosis was the main cause of death in either singleton or twin preterm infants with NEC.After 1 year of follow-up, there was no significant difference in the proportion of growth retardation, the proportion of serious neurodevelopmental problems and mortality between the 2 groups (all P>0.05). Conclusions:Twin preterm infants born with poor physical fitness, and they have a high incidence of NEC with a rapid progression that require the early intervention.The operation rate of twin preterm infants with NEC is high and the postoperative complications are serious.Close observation, reasonable analysis, early prevention and intervention are needed to reduce the incidence and mortality of twin preterm infants with NEC and improve the prognosis.