VIÊM RUỘT HOẠI TỬ Ở TRẺ SƠ SINH NON THÁNG: CÁC YẾU TỐ LIÊN QUAN ĐẾN TỬ VONG TỪ MỘT NGHIÊN CỨU CẮT NGANG

Abstract

Background: Necrotizing enterocolitis (NEC) is a serious condition characterized by inflammation and necrosis of the intestinal mucosa, primarily due to intestinal ischemia. It is often associated with excessive gas-producing bacterial proliferation in the gut lumen, leading to gas infiltration into the intestinal wall (pneumatosis intestinalis) and potentially into the portal venous system (portal venous gas). Severe complications include peritonitis, intestinal perforation, and even death if not promptly intervened. NEC remains one of the leading causes of mortality and morbidity in premature infants, particularly those with very low birth weight. In Vietnam, approximately 80–90% of NEC cases occur in preterm infants ^[2], with mortality rates reaching up to 50% in extremely low birth weight neonates ^[1].

Objective: To identify factors associated with mortality in necrotizing enterocolitis among premature newborns at Children’s Hospital 1.Methods: A cross-sectional study conducted from January 2022 to August 2025 at Children’s Hospital 1.

Results: During the study period, a total of 101 premature newborns were diagnosed with necrotizing enterocolitis, with a median gestational age of 31.9 weeks (interquartile range 28.0–33.6 weeks), median birth weight of 1300 g (1100–2000 g), and 22.8% being extremely preterm. The main clinical symptoms included abdominal distension (99.0%), brown gastric drainage (75.2%), bloody stools (33.7%), and respiratory distress (59.4%). At the most severe stage, common laboratory abnormalities were thrombocytopenia (37.6%), coagulopathy (36.6%), and metabolic acidosis (35.6%); blood cultures were positive in 23.8% of cases, with Candida spp. and coagulase-negative Staphylococci each accounting for 29.2%. Imaging findings showed pneumatosis intestinalis on abdominal ultrasound (82.2%) and free intraperitoneal fluid (49.5%), as well as dilated bowel loops with pneumatosis (59.4%) and pneumatosis intestinalis (46.5%) on abdominal X-ray. According to the modified Bell staging, the distribution was IIA (31.7%), IIB (33.7%), IIIA (7.9%), and IIIB (26.7%). Common comorbidities included sepsis (68.3%), respiratory distress syndrome (56.4%), pneumonia (45.5%), and patent ductus arteriosus (27.7%). Regarding treatment, the median duration of total parenteral nutrition was 8 days (5–10 days), with a surgical intervention rate of 33.7% and preoperative peritoneal drainage in 26.7%. The overall mortality rate was 19.8%. Multivariate logistic regression analysis revealed that severe metabolic acidosis (pH < 7.2) (OR = 12.1, 95% CI: 2.0–71.5) and thrombocytopenia (OR = 5.0, 95% CI: 1.2–22.0) were independent factors associated with mortality.

Conclusion: Thrombocytopenia (< 100 × 10⁹/L) and severe metabolic acidosis (pH < 7.2) are independent factors associated with mortality in NEC. Early detection and timely management of these abnormalities may help limit disease progression and improve treatment outcomes in premature infants with necrotizing enterocolitis.