NEONATAL SURGICAL DATABASE: NECROTIZING ENTEROCOLITIS (NEC) PROTOCOL

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 对大量患有坏死性小肠结肠炎(NEC)的早产儿的前瞻性数据收集将准确地定义这种毁灭性疾病的自然病史。这些数据还将允许定义发生严重NEC的风险因素和目前治疗NEC的做法的结果。 儿科外科医生经常照顾患有罕见疾病的儿童。尤其是严重的新生儿外科疾病，如坏死性小肠结肠炎(NEC)。即使是主要的儿科转诊中心也不会看到足够数量的患者来有意义地评估机构的S治疗方法的结果。因此，关于NEC儿童护理的科学文献几乎完全由轶事病例报告和单个机构的病例系列数据组成。格拉泽研究网络成立于2001年，旨在协调6个机构(贝勒、哈佛、旧金山大学、斯坦福大学、南加州大学、加州大学洛杉矶分校)之间的数据收集。通过结合这6个机构关于婴儿NEC的数据，可以进行更有意义的分析。 坏死性小肠结肠炎是一种严重的肠道炎症性疾病，发生在早产儿和低出生体重儿中。NEC最早于1060年被描述为S，现在是新生儿最常见的外科急症。据报道，新生儿重症监护病房(NICU)入院的NEC发病率为1%至5%，即每1000名活产中有1至3例。根据国家卫生统计中心和多中心试验的数据分析，美国每年约有1万例NEC病例。这导致每年约2500人死亡。NEC的发生率与早产程度密切相关。正是这些极低出生体重的婴儿给医生带来了最大的临床挑战。由于NEC的成功治疗通常会导致儿童能够过上健康和富有成效的生活，因此改善护理可以在挽救生命的年数方面产生巨大影响。 NEC的临床表现可从喂养不耐受到严重败血症伴心血管衰竭。目前还没有针对NEC的明确治疗方法。大多数病例对停止口服喂养、鼻胃减压、液体复苏、广谱抗生素和其他支持性措施有反应。严重的NEC可导致肠坏死和穿孔。当这些情况发生时，手术干预是必要的。 一旦确诊为NEC，实施标准是进行肠道休息、胃减压和广谱抗生素。许多患者对这种治疗反应良好，无需进一步干预即可康复。另一些恶化并发展为肠坏死或穿孔，需要紧急手术。几乎没有可用的证据表明，哪些因素可以帮助预测哪些婴儿最有可能恶化。到目前为止，还没有大型前瞻性研究跟踪调查被诊断为NEC的婴儿并确定他们的病程。识别恶化的风险因素可以使更密集的治疗集中在那些最有可能受益的人身上。此外，这样的数据可以更快地恢复肠道喂养，并为那些没有高风险的人提供新生儿护理。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The prospective collection of data on a large cohort of premature infants with necrotizing enterocolitis (NEC) will accurately define the natural history of this devastating disease. These data will also permit definition of risk factors for developing severe NEC and the outcome of current practices in the treatment of NEC. Pediatric surgeons often care for children with uncommon diseases. This is particularly true of major neonatal surgical disorders such as Necrotizing Enterocolitis (NEC). Even a major pediatric referral center will not see an adequate number of patients to meaningfully assess outcomes from the institution''s treatment approach. For this reason, the scientific literature on the care of children with NEC is almost exclusively comprised of anecdotal case reports and single-institution case-series data. The Glaser Research Network was established in 2001 to coordinate data collection between 6 institutions (Baylor, Harvard, University of San Francisco, Stanford, USC, UCLA). By combining data from these 6 institutions on infants with NEC a more meaningful analysis can be carried out. Necrotizing Enterocolitis is a severe inflammatory disease of the intestine that occurs in premature and low birth weight infants. First described in the 1060's, NEC is now the most common surgical emergency in the newborn infant. The incidence of NEC is reported to be from 1% to 5% of neonatal intensive care unit (NICU) admissions or 1 to 3 cases per 1,000 live births. Based upon analysis of data from the National Center for Health Statistics and multi-center trials, there are about 10,000 cases of NEC per year in the United States. This results in approximately 2500 deaths per year. The incidence of NEC correlates strongly with the degree of prematurity. It is these very low birth weight babies that present the physician with the greatest clinical challenge. Since successful treatment of NEC typically results in the child being able to lead a healthy and fully productive life, improvements in care can produce a tremendous impact in terms of number of years of life saved. The clinical presentation of NEC can range from feeding intolerance to severe sepsis with cardiovascular collapse. No definitive treatment for NEC exists. Most cases respond to discontinuation of oral feedings with nasogastric decompression, fluid resuscitation, broad-spectrum antibiotics, and other supportive measures. Severe NEC can result in intestinal necrosis and perforation. When these conditions occur, surgical intervention is necessary. Once the diagnosis of NEC is made, standard of practice is to institute bowel rest, gastric decompression, and broad spectrum antibiotics. Many patients respond well to this treatment and recover with no further intervention. Others deteriorate and develop intestinal necrosis or perforation requiring urgent operation. There is little available evidence to suggest what factors may help predict which infants are most likely to deteriorate. To date, no large prospective studies have followed infants diagnosed with NEC and determined their course. Identification of risk factors for deterioration could allow more intensive therapy to be focused on those most likely to benefit. In addition, such data could allow a more rapid return to enteral feeding and routing neonatal care for those not at high risk.