周産期センターにおける壊死性腸炎症例の検討

概要

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We studied infants of necrotizing enterocolitis (NEC) who were born at our perinatal referring center. Between 1981 and 1991, fifteen newborns developed NEC with Bell's stage II and III, including 9 extremely-low-birth weights (ELBW ; < 1000g), and 5 very-low-birth weights (VLBW ; 1000-1499g). The incidence of NEC was 0.5% for all the patients who were housed in the NICU, 2.1% for ELBW, and 0.8% for VLBW. Fou rrecoovered with intensive medical treatment. Two ELBW infants had no indication for operation because of very severe intracranial hemorrhage and septic shock. Nine including 6 who did not improve with medical treatment and 3 who showed very rapid deterioration within 24 hours after the onset underwent operation. The indications for operation were persisting metabolic acidosis in 2, and intestinal perforation in 7. Resection of necrotic bowel with jejunostomy or ileostomy was done in all infants except one who died during operation. After the operation, whole blood exchange transfusion was performed for each patient 1 to 4 times. Six tolerated the operation, and 3 died during the operation or within 3 days after operation. Positive blood culture, uncorrected metabolic acidosis and anuria at the time of operation werecondidered to be poor prognotic factors. Early operation was recommended to improve the prognosis of NEC.
1992-12-20