Can a national dataset generate a nomogram for necrotizing enterocolitis onset?
Can a national dataset generate a nomogram for necrotizing enterocolitis onset?
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DOI：
10.1038/jp.2014.137
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发表时间：
2014-10-01
影响因子：
2.9
通讯作者：
Spitzer, A.
中科院分区：
文献类型：
--
作者：
Gordon, P. V.;Clark, R.;Spitzer, A.
目的：作为预防坏死性小肠结肠炎 (NEC) 的一种手段，母乳和捐赠母乳的使用正在增加。早期开始肠内喂养与许多结局的改善相关，但尚未被证明可以降低 NEC 的发生率。按妊娠层更好地定义 NEC 风险窗口应能改善捐赠母乳的资源管理，并增强我们对 NEC 发生时间和发病机制的理解。我们的目标是建立足够大小和质量的 NEC 数据集，然后从跨妊娠层的数据集构建 NEC 发病的通用模型。 研究设计：我们使用 Pediatrix 国家数据集中的去识别化数据，过滤掉可以通过特定诊断或逻辑排除（例如双重诊断）识别的所有诊断混杂因素，特别关注 NEC 和自发性肠穿孔 (SIP) 作为感兴趣的结果。将中位发病日与每项诊断的孕龄作图，并分析诊断日的相似性和差异。结果：医学 NEC 的发病时间与妊娠成反比，在所有孕龄中均呈线性关系。我们发现医学 NEC 数据集显示的特征与同质疾病实体最一致，而手术 NEC 的最年轻妊娠组中存在早期表现的偏差（表明可能存在 SIP 污染）。 结论：我们的国家数据集表明，NEC 的发病与出生时的胎龄呈相反的刻板印象线性关系。医疗 NEC 是确定 NEC 风险时间窗口最可靠的子队列。
OBJECTIVE: Mother's own milk and donor human milk use is increasing as a means of necrotizing enterocolitis (NEC) prevention. Early onset of enteral feeding has been associated with improvement of many outcomes but has not been shown to reduce the incidence of NEC. Better definition of the window of risk for NEC by gestational strata should improve resource management with respect to donor human milk and enhance our understanding of NEC timing and pathogenesis. Our objective was to establish a NEC dataset of sufficient size and quality, then build a generalizable model of NEC onset from the dataset across gestational strata.STUDY DESIGN: We used de-identified data from the Pediatrix national dataset and filtered out all diagnostic confounders that could be identified by either specific diagnoses or logical exclusions (example dual diagnoses), with a specific focus on NEC and spontaneous intestinal perforation (SIP) as the outcomes of interest. The median day of onset was plotted against the gestational age for each of these diagnoses and analyzed for similarities and differences in the day of diagnosis.RESULT: Onset time of medical NEC was inversely proportional to gestation in a linear relationship across all gestational ages. We found the medical NEC dataset displayed characteristics most consistent with a homogeneous disease entity, whereas there was a skew towards early presentation in the youngest gestation groups of surgical NEC (suggesting probable SIP contamination).CONCLUSION: Our national dataset demonstrates that NEC onset occurs in an inverse stereotypic, linear relationship with gestational age at birth. Medical NEC is the most reliable sub-cohort for the purpose of determining the temporal window of NEC risk.