Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children's hospital in the last 10 years

Autoři: Lu Lin aff001;  Xuhua Xia aff001;  Wei Liu aff002;  Yongming Wang aff001;  Ziyu Hua aff001
Působiště autorů: Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, P.R China aff001;  National Clinical Research Center for Child Health and Disorders, Chongqing, P.R China aff002;  China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R China aff003;  Department of Gastrointestinal and Neonatal Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, P.R China aff004;  Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, P.R China aff005;  Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R China aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224880


The aim of this retrospective study was to explore the risk factors and clinical characteristics related to neonatal fulminant necrotizing enterocolitis (NEC). From 1 November 2007 to 31 October 2017, 352 neonates who were diagnosed with NEC (Bell stage ≥ΠB) and admitted to the Children’s Hospital of Chongqing Medical University were enrolled. Among these patients, 112 (31.82%) cases fulfilled the definition of fulminant NEC, and 62.5% (70/112) of fulminant cases presented a poor prognosis. All the survivors in the fulminant NEC group underwent surgery. Those in the fulminant NEC group were more likely to have the following clinical features: sepsis preceding NEC (P<0.001), abdominal distention (P<0.001), bowel sound disappearance (P = 0.001), leukopenia or neutropenia (P<0.001), C-reactive protein (CRP) <10 mg/L (P = 0.003), procalcitonin (PCT) < 2 μg/L (P<0.001), pH ≤7.2 (P<0.001), and radiographic evidence of pneumoperitoneum (P<0.001) or seroperitoneum on ultrasonography (P = 0.017). In conclusion, fulminant NEC is characterized by urgent onset and prompt deterioration, potentially resulting in death. The lack of unique characteristics makes it difficult to recognize by medical caregivers. Close observation, early detection and timely surgical intervention may improve the prognosis.

Klíčová slova:

Birth weight – Blood – Gastrointestinal tract – Infants – Neonates – Pediatrics – Prognosis – Surgical and invasive medical procedures


1. Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Seminars in neonatology: SN. 2003;8(6):449–59. Epub 2004/03/06. doi: 10.1016/S1084-2756(03)00123-4 15001117.

2. Covert RF, Neu J, Elliott MJ, Rea JL, Gimotty PA. Factors associated with age of onset of necrotizing enterocolitis. Am J Perinatol. 1989;6(4):455–60. Epub 1989/10/01. doi: 10.1055/s-2007-999639 2789545.

3. Morgan JA, Young L, McGuire W. Pathogenesis and prevention of necrotizing enterocolitis. Current Opinion in Infectious Diseases. 2011;24(3):183–9. doi: 10.1097/QCO.0b013e328345d5b5 21455063

4. Hummer P, Klein P, Mang K. [Procedures in fulminant courses of necrotizing enterocolitis]. Langenbecks Archiv fur Chirurgie. 1986;369:673–6. Epub 1986/01/01. doi: 10.1007/bf01274459 3807587.

5. Voss M, Moore SW, van der Merwe I, Pieper C. Fulminanting necrotising enterocolitis: outcome and prognostic factors. Pediatric surgery international. 1998;13(8):576–80. Epub 1998/11/03. doi: 10.1007/s003830050407 9799379.

6. Lambert DK, Christensen RD, Baer VL, Henry E, Gordon PV, Besner GE, et al. Fulminant necrotizing enterocolitis in a multihospital healthcare system. Journal of perinatology: official journal of the California Perinatal Association. 2012;32(3):194–8. Epub 2011/05/14. doi: 10.1038/jp.2011.61 21566569.

7. Hammond PJ, Flett ME, De La Hunt M. Fulminant necrotising enterocolitis immediately following change to low birth weight formula feeds. European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery [et al] = Zeitschrift fur Kinderchirurgie. 2008;18(3):185–7. Epub 2008/05/22. doi: 10.1055/s-2008-1038440 18493895.

8. Ron O, Davenport M, Patel S, Kiely E, Pierro A, Hall NJ, et al. Outcomes of the "clip and drop" technique for multifocal necrotizing enterocolitis. Journal of pediatric surgery. 2009;44(4):749–54. Epub 2009/04/14. doi: 10.1016/j.jpedsurg.2008.09.031 19361635.

9. Christensen RD, Gordon PV, Besner GE. Can we cut the incidence of necrotizing enterocolitis in half—today? Fetal and pediatric pathology. 2010;29(4):185–98. Epub 2010/07/03. doi: 10.3109/15513815.2010.483874 20594142.

10. Gordon PV. What progress looks like in NEC research. Journal of perinatology: official journal of the California Perinatal Association. 2011;31(3):149. Epub 2011/02/26. doi: 10.1038/jp.2010.164 21350562.

11. Neu J. Necrotizing enterocolitis: the mystery goes on. Neonatology. 2014;106(4):289–95. Epub 2014/08/30. doi: 10.1159/000365130 25171544.

12. Xueqiu W, Shi C, Lu G, Xiaoyu H, Zhengli W, Yu H, et al. Comparison of clinical features of necrotizing enterocolitis with spontaneous intestinal perforation in infants. Journal of Clinical Pediatrics. 2018;36(11):871–4. (in chinese)

13. Gagliardi L, Bellu R, Cardilli V, De Curtis M. Necrotising enterocolitis in very low birth weight infants in Italy: incidence and non-nutritional risk factors. Journal of pediatric gastroenterology and nutrition. 2008;47(2):206–10. Epub 2008/07/31. doi: 10.1097/MPG.0b013e318174e855 18664876.

14. Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, et al. Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants. Jama. 2016;315(9):889–97. Epub 2016/03/05. doi: 10.1001/jama.2016.1204 26934258; PubMed Central PMCID: PMC4805423.

15. Bhatia J. Strategies to prevent necrotising enterocolitis. Chinese medical journal. 2010;123(20):2759–65. Epub 2010/11/03. 21034578.

16. Silverman MA, Konnikova L, Gerber JS. Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea. Gastroenterology clinics of North America. 2017;46(1):61–76. Epub 2017/02/07. doi: 10.1016/j.gtc.2016.09.010 28164853; PubMed Central PMCID: PMC5314436.

17. Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. The Journal of pediatrics. 2011;159(3):392–7. Epub 2011/04/15. doi: 10.1016/j.jpeds.2011.02.035 21489560; PubMed Central PMCID: PMC3137655.

18. Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. The Journal of pediatrics. 2011;159(5):720–5. Epub 2011/07/26. doi: 10.1016/j.jpeds.2011.05.033 21784435; PubMed Central PMCID: PMC3193552.

19. Lamy B, Dargere S, Arendrup MC, Parienti JJ, Tattevin P. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Frontiers in microbiology. 2016;7:697. Epub 2016/06/01. doi: 10.3389/fmicb.2016.00697 27242721; PubMed Central PMCID: PMC4863885.

20. Ruan L, Chen GY, Liu Z, Zhao Y, Xu GY, Li SF, et al. The combination of procalcitonin and C-reactive protein or presepsin alone improves the accuracy of diagnosis of neonatal sepsis: a meta-analysis and systematic review. Critical care (London, England). 2018;22(1):316. Epub 2018/11/23. doi: 10.1186/s13054-018-2236-1 30463590; PubMed Central PMCID: PMC6249912.

21. Yu Z, Liu J, Sun Q, Qiu Y, Han S, Guo X. The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: a meta-analysis. Scandinavian journal of infectious diseases. 2010;42(10):723–33. Epub 2010/09/16. doi: 10.3109/00365548.2010.489906 20840003.

22. Bell SG. Procalcitonin and Neonatal Sepsis: Is This the Biomarker We Are Looking For? Neonatal network: NN. 2017;36(6):380–4. Epub 2017/12/01. doi: 10.1891/0730-0832.36.6.380 29185950.

23. Kling PJ, Hutter JJ. Hematologic abnormalities in severe neonatal necrotizing enterocolitis: 25 years later. Journal of perinatology: official journal of the California Perinatal Association. 2003;23(7):523–30. Epub 2003/10/21. doi: 10.1038/ 14566346.

24. Hutter JJ Jr., Hathaway WE, Wayne ER. Hematologic abnormalities in severe neonatal necrotizing enterocolitis. The Journal of pediatrics. 1976;88(6):1026–31. Epub 1976/06/11. doi: 10.1016/s0022-3476(76)81069-4 1271173.

Článek vyšel v časopise


2019 Číslo 11