ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ VIÊM RUỘT HOẠI TỬ Ở TRẺ SƠ SINH NON THÁNG TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory condition with necrosis of the intestinal mucosa due to ischemia, accompanied by the growth of gas-forming bacteria in the gut. This condition may result in intramural and portal venous gas, with possible progression to peritonitis, intestinal perforation, and death. NEC remains one of the leading causes of morbidity and mortality in preterm infants, particularly those with very low birth weight. In Vietnam, 80–90% of NEC cases occur in preterm neonates^[2], with mortality rates reaching up to 50% in this vulnerable population^[1]. Objectives: To determine the percentage of clinical features and treatment outcomes of necrotizing enterocolitis in preterm infants at Children's Hospital 1. Methods: Cross-sectional study from January 2022 to August 2025 at Children's Hospital 1. Results: A total of 101 cases of NEC were identified in preterm infants during the study period. The median gestational age was 31.9 weeks (28.0–33.6 weeks), the median birth weight was 1300 g (1100–2000 g), and the proportion of extremely preterm infants was 22.8%. The predominant clinical manifestations were abdominal distension (99.0%), gastric residuals with brownish aspirates (75.2%), hematochezia (33.7%), and respiratory failure (59.4%). The principal paraclinical abnormalities at the time of maximum clinical severity included thrombocytopenia (37.6%), coagulopathy (36.6%), and metabolic acidosis (35.6%). Blood cultures were positive in 23.8% of cases, with Candida spp. (29.2%) and coagulase-negative Staphylococci (29.2%) being the most frequently isolated organisms. Common imaging findings were as follows: on abdominal ultrasound, pneumatosis intestinalis (82.2%), free peritoneal fluid (49.5%); on abdominal radiography, bowel loop dilatation (59.4%), and pneumatosis intestinalis (46.5%). NEC staging in preterm infants according to the modified Bell’s criteria was distributed as follows: stage IIA (31.7%), IIB (33.7%), IIIA (7.9%), and IIIB (26.7%). Common coexisting diagnoses included sepsis (68.3%), respiratory distress syndrome (56.4%), pneumonia (45.5%), and patent ductus arteriosus (27.7%). The principal treatment modalities consisted of total parenteral nutrition with a median duration of 8 days (5–10 days), surgical intervention (33.7%), and preoperative peritoneal drainage (26.7%). The overall mortality rate was 19.8%. Conclusion: The most frequent NEC stage in preterm infants according to the modified Bell’s criteria was IIB (33.7%). Common coexisting diagnoses included sepsis (68.3%), and respiratory distress syndrome (56.4%). The rate of NEC requiring surgery was 33.7%. The mortality rate was  19.8%. Appropriate diagnostic and treatment strategies are needed to reduce mortality in necrotizing enterocolitis in preterm infants.