Journal Article

Gestational age-dependent clinical characteristics of necrotizing enterocolitis-associated intestinal perforation: a 10-year cohort study

Chen, Feng, Hu, Ya, Yue, Weihong, Wei, Hong, Liu, Xia, Liu, Gege

2025

Overview

Objective To delineate gestational age (GA)-dependent pathophysiology of necrotizing enterocolitis-associated intestinal perforation (NEC-IP) and establish precision management protocols. Methods A single-center retrospective cohort study (2013–2023) included 66 preterm (< 37 weeks) and 38 term (≥ 37 weeks) neonates with NEC-associated perforations. Outcomes included anatomical distribution, microbiological profiles, management disparities, and prognoses. Results Preterm infants exhibited significantly higher rates of twin gestation (43.9% vs 7.9%, p  = 0.003), antenatal steroid exposure (43.9% vs 2.6%, p  < 0.001), and preoperative fasting rate (33.3% vs 7.9%, p  = 0.009) compared to term infants. Preterm infants demonstrated Gram-positive bacteremia (83.3%) with Gram-negative peritoneal predominance (83.9%), alongside significantly lower leukocyte counts (Stage 2:12.6 vs 14.9 × 10⁹/L, Stage 3: 9.1 vs 11.1 × 10⁹/L, both p  < 0.05), platelet levels (all stage), and hemoglobin levels (Stage 1:125.1 vs 141.6 × 10 12 /L, p  = 0.004). Term infants showed Gram-positive peritoneal dominance (76.2%) with classic peritonitis signs (hematochezia 68.4%, abdominal tenderness 55.3%). Lleal perforations predominated in preterms (69.7% vs 21.1%, p  < 0.001), whereas colonic involvement was prevalent in terms (63.1%). Prolonged parenteral nutrition in preterms (27.0 vs 20.0 days, p  = 0.009) correlating with prolonged hospitalization (38.4 ± 9.7 vs 23.5 ± 8.1 days; p  < 0.001), achieved higher enteral tolerance (151.7 vs 134.2 ml/kg/d, p  = 0.009). There was no case dead in initial admission. Rehospitalization and mortality rates in readmission were comparable (term 73.7 vs preterm 60.6%, p = 0.177;1% vs 2%; p  = 0.653). Although weight at discharge in term group was higher compared to preterm infants (2.5 ± 0.4 vs 3.5 ± 0.6 kg; p  < 0.001), while weight velocity was similar between two groups (18.3 ± 7.5 vs 16.6 ± 9.6 g.kg⁻ 1 ·d⁻ 1 ; p  = 0.312). Conclusion GA-specific NEC-IP mechanisms mandate: (1) preterm-focused ileal exploration & Gram-negative coverage, (2) term-focused retroperitoneal debridement & Gram-positive control, and (3) GA-stratified diagnostic framework integrating clinical signs and imaging. This precision approach reduces missed perforations and surgical delays.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Analysis / Care and treatment / Cohort Studies / Diagnosis / Enterocolitis, Necrotizing - complications / Enterocolitis, Necrotizing - microbiology / Enterocolitis, Necrotizing - therapy / Enterocolitis, Neonatal necrotizing / Enterocolitis, Pseudomembranous / Female / Gastroenterology / Gestational Age / Health aspects / Hepatology / Humans / Infant, Newborn / Infant, Premature / Infant, Premature, Diseases - microbiology / Infant, Premature, Diseases - therapy / Injuries / Internal Medicine / Intestinal perforation / Intestinal Perforation - etiology / Intestinal Perforation - microbiology / Intestinal Perforation - physiopathology / Intestinal Perforation - therapy / Intestines / Male / Medicine / Medicine & Public Health / Necrotizing enterocolitis / Neonate / Physiology, Pathological / Prognosis / Retrospective Studies / Risk factors