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Background: Necrotizing enterocolitis (NEC) is one of the most common and devastating diseases that occurs in neonates, and often requires surgical intervention. Hyperglycemia or hypoglycemia can easily occur in newborns, due to their metabolic immaturity. It remains unknown how factors associated with anesthesia especially perioperative glucose level affect the surgical outcomes of neonates with NEC. In this retrospective observational study, we analyzed the risk factors associated with prolonged hospitalization among neonates who received surgical treatment for necrotizing enterocolitis.Methods: From January 2016 to October 2019, a total of 204 infants with a gestational age of 28 weeks to 40 weeks underwent open surgery for NEC at Shengjing Hospital of China Medical University. Among those infants, 111 patients were assigned to the well glycemic control group and 93 patients were assigned to the poor glycemic control group. The primary study outcome was the length of postoperative hospital stay. Risk factors that may affect surgical outcomes were collected and analyzed via multivariate logistic regression to determine their association with postoperative hospital stay.Results: A multivariate logistic regression analysis showed that high preoperative weight (OR=0.995, 95%CI=0.992-0.997, p<0.001) and well glycemic control (OR=0.129, 95%CI=0.031-0.535, p=0.005) were independent protective factors for prolonged hospital stay, whereas long duration of endotracheal intubation in NICU(OR=1.239, 95%CI=1.016-1.512 , p=0.035) and long days of antibiotics use (OR=1.421, 95%CI=1.233-1.637, p<0.001) were independent risk factors for prolonged hospital stay. Patients with perioperative blood glucose control within the prespecified range(47-150mg/dL) had shorter postoperative hospital stays than those with perioperative blood glucose measurements outside those limits (22 [18,26] vs 29 [24.5,36.5] days, p <0.001).Conclusions: Glucose levels outside a pre-specified range were an independent risk factor for a prolonged hospital stay in a population of neonates who underwent surgical repair for NEC.
Purpose
The physiologic transition from a fetus to a neonate is composed of a series of complex processes that include changes in cerebral tissue oxygenation saturation (cSO
2
). Monitoring this process is of great importance. This study aimed to define the cSO
2
reference interval in neonates without medical support, extending the measurements until 1 hour after birth, and to determine the incidence of abnormally low or high regional cerebral oxygenation during the neonatal transition.
Patients and Methods
A total of 418 neonates delivered by cesarean section were enrolled. Near-infrared spectroscopy was used to monitor cerebral oxygenation.
Results
We found that cSO
2
of the non-oxygen-inhaled intrathecal anesthesia in neonates without medical support increased from about 49.0% in the second minute. Most of them reached cSO
2
relative stabilization at 55.7–81.0% between 7 and 8 minutes after birth. One hour after birth, newborn cSO
2
was maintained at 78.0–87.0%. The low cSO
2
rate among babies born under intrathecal anesthesia with and without maternal oxygen inhalation during cesarean sections was approximately 4.5% and 9.0%, respectively.
Conclusion
We reported the trend in cSO
2
from 2 minutes after birth to 1 hour in the neonatal nursing room and determined the incidence of abnormal regional cSO
2
during this neonatal transition period. Anesthesiologists should pay special attention to the risk of cSO
2
abnormalities in newborns when managing pregnant women with comorbidities.
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