Risk factors analysis and management strategy optimization for postoperative complications in neonatal necrotizing enterocolitis: A single-center retrospective study

Table 1 Univariate analysis of factors associated with postoperative complications of neonatal necrotizing enterocolitis, n (%)/median (interquartile range)/mean ± SD

Variable	Complication group (n = 28)	No-complication group (n = 34)	χ2/t/Z	P value
Sex			χ2 = 0.125	0.724
Male	16 (57.14)	21 (61.76)
Female	12 (42.86)	13 (38.24)
Gestational age (weeks)	30.82 ± 2.51	34.15 ± 2.95	t = 4.782	< 0.001
Birth weight (g)	1350 (980, 1680)	2100 (1580, 2780)	Z = 4.256	< 0.001
Mode of delivery			χ2 = 0.706	0.401
Vaginal delivery	11 (39.29)	17 (50.00)
Cesarean section	17 (60.71)	17 (50.00)
Multiple gestation	7 (25.00)	5 (14.71)	χ2 = 1.051	0.305
Antenatal steroid use	20 (71.43)	18 (52.94)	χ2 = 2.143	0.143
Age at diagnosis (days)	13.46 ± 5.25	11.82 ± 4.76	t = 1.310	0.195
Bell stage			χ2 = 1.237	0.266
Stage II	6 (21.43)	12 (35.29)
Stage III	22 (78.57)	22 (64.71)
Preoperative mechanical ventilation	25 (89.29)	23 (67.65)	χ2 = 4.085	0.043
Preoperative hemodynamic instability	20 (71.43)	8 (23.53)	χ2 = 14.385	< 0.001
Preoperative laboratory parameters
Lowest preoperative white blood cell count (× 109/L)	7.52 ± 3.85	9.01 ± 4.12	t = -1.488	0.142
Lowest preoperative platelet count (× 109/L)	78.21 ± 45.36	135.88 ± 65.74	t = -4.025	< 0.001
Peak preoperative C-reactive protein (mg/L)	92.35 ± 48.21	85.67 ± 51.43	t = 0.528	0.599
Peak preoperative blood lactate (mmol/L)	4.51 ± 1.80	3.20 ± 1.20	t = 3.412	0.001
Timing of surgery			χ2 = 5.822	0.016
≤ 48 hours	9 (32.14)	22 (64.71)
> 48 hours	19 (67.86)	12 (35.29)
Surgical procedure			χ2 = 6.504	0.039
Primary anastomosis	5 (17.86)	14 (41.18)
Bowel resection with stoma	21 (75.00)	18 (52.94)
Others	2 (7.14)	2 (5.88)
Resection involving terminal ileum	23 (82.14)	20 (58.82)	χ2 = 3.853	0.050
Length of bowel resection			χ2 = 9.259	0.002
≤ 30 cm	11 (39.29)	27 (79.41)
> 30 cm	17 (60.71)	7 (20.59)
Operation time (minutes)	135.41 ± 35.22	120.26 ± 30.15	t = 1.825	0.073
Intraoperative blood loss (mL)	28.21 ± 15.34	21.76 ± 12.87	t = 1.805	0.076
Peritoneal lavage	26 (92.86)	30 (88.24)	χ2 = 0.416	0.519
Duration of postoperative mechanical ventilation (days)	8.68 ± 4.52	5.12 ± 3.21	t = 3.650	0.001
Duration of postoperative vasoactive drug use (days)	5.0 (3.0, 8.0)	2.0 (1.0, 4.0)	Z = 3.981	< 0.001
Serum albumin on postoperative day 3 (g/L)	28.51 ± 3.48	32.03 ± 3.02	t = 4.215	< 0.001
Time to initiation of enteral nutrition (days)	10.25 ± 4.83	6.71 ± 2.95	t = 3.576	< 0.001
Time to full enteral nutrition (days)	28.0 (21.0, 42.0)	18.0 (14.0, 25.0)	Z = 4.562	< 0.001
Postoperative length of hospital stay (days)	55.0 (42.0, 78.0)	32.0 (25.0, 45.0)	Z = 4.879	< 0.001

Table 2 Multivariate logistic regression analysis of factors associated with postoperative complications of neonatal necrotizing enterocolitis

Variable	β	SE	Wald χ2	P value	OR (95%CI)
Gestational age < 32 weeks	0.922	0.586	2.517	0.113	2.51 (0.81-7.79)
Birth weight < 1500 g	1.054	0.602	3.065	0.080	2.86 (0.88-9.28)
Preoperative mechanical ventilation required	0.883	0.627	2.013	0.156	2.41 (0.72-8.10)
Preoperative hemodynamic instability	1.675	0.558	9.234	0.002	5.32 (1.84-15.39)
Preoperative platelet count < 100 × 109/L	0.767	0.563	1.843	0.175	2.14 (0.72-6.38)
Preoperative blood lactate > 3.5 mmol/L	0.826	0.575	2.076	0.150	2.27 (0.74-6.96)
Time to surgery > 48 hours	0.698	0.591	1.372	0.242	1.99 (0.63-6.31)
Surgical procedure (stoma vs anastomosis)	0.543	0.586	0.863	0.354	1.72 (0.55-5.36)
Length of bowel resection > 30 cm	1.434	0.524	7.561	0.006	4.18 (1.51-11.56)
Postoperative mechanical ventilation > 7 days	1.180	0.503	5.564	0.019	3.25 (1.21-8.74)
Postoperative vasoactive drug use > 3 days	0.611	0.541	1.285	0.258	1.84 (0.64-5.29)
Serum albumin on postoperative day 3 < 30 g/L	1.339	0.512	6.805	0.008	3.77 (1.42-10.00)
Time to initiation of enteral nutrition > 7 days	0.725	0.557	1.718	0.191	2.05 (0.70-6.02)
Time to full enteral nutrition > 21 days	0.854	0.568	2.307	0.129	2.34 (0.78-7.02)
Postoperative hospital stay > 40 days	1.023	0.605	2.892	0.089	2.77 (0.86-8.94)
Constant	-2.896	0.815	12.749	< 0.001	0.06

OR: Odds ratio; CI: Confidence interval.