Arginine supplementation prevents necrotizing enterocolitis in the premature infant

OBJECTIVES: To determine whether supplementation with L -arginine reduces the incidence of all stages of necrotizing enterocolitis (NEC) in premature infants with birth weight < or =1250 g and gestational age < or =32 weeks. STUDY DESIGN: In a randomized, double-blind, placebo-controlled study, 152 premature infants were prospectively, randomly assigned to receive either supplemental L -arginine (1.5 mmol/kg per day; n =75 [group A]) or placebo (control group; n = 77 [group B]) with oral feeds/parenteral nutrition during the first 28 days of life. Nutrient intake, plasma ammonia, arginine, and amino acid concentrations were measured in all infants at days 3, 14, and 28 and at the time of diagnosis of NEC. RESULTS: NEC developed in 5 infants in group A compared with 21 infants in group B (P <.001). Arginine intake and plasma arginine concentrations were similar in both groups at study entry and (as expected) increased in group A at days 14 and 28. Plasma arginine concentrations were lower in both groups at time of diagnosis of NEC. No significant differences in maternal and neonatal demographics, nutrient intake, plasma ammonia and total and essential amino acid concentrations were present between the two groups. CONCLUSIONS: Arginine supplementation (1.5 mmol/kg per day) in premature infants reduces the incidence of all stages of NEC.     

Early feeding after necrotizing enterocolitis in preterm infants

OBJECTIVE: To report our experience with an early initiation of enteral feedings after necrotizing enterocolitis (NEC). STUDY DESIGN: Over a 4-year period, all inborn infants with NEC Bell stage II or greater received enteral feedings, increased by 20 mL/kg/d, once no portal vein gas had been detected on ultrasound for 3 consecutive days (group 1). Infants were compared with a historic comparison group (group 2). RESULTS: Necrotizing enterocolitis rates were 5% (26/523) in the early feeding group and 4% (18/436) in the comparison group. One early feeding infant and two comparison group infants died of NEC, whereas two and one, respectively, had recurrent NEC. Enteral feedings were restarted at a median of 4 days (range, 3-14) versus 10 days (range, 8-22) after onset of NEC. Early feeding was associated with shorter time to reach full enteral feedings (10 days [range, 7-31] vs 19 days [range, 9-76], P<.001), a reduced duration of central venous access (13.5 days [range, 8-24] vs 26.0 days [range, 8-39], P<.01), less catheter-related septicemia (18% vs 29%, P<.01), and a shorter duration of hospital stay (63 days [range, 28-133] vs 69 days [range, 36-150], P<.05). CONCLUSION: Early enteral feeding after NEC was associated with significant benefits and no apparent adverse effects. This study was underpowered, however, to exclude a higher NEC recurrence risk potentially associated with this change in practice.     

Does necrotising enterocolitis impact the neurodevelopmental and growth outcomes in preterm infants with birthweight ≤1250 g?

AIM: To compare the long-term growth and neurodevelopmental outcomes at 36 months adjusted age in preterm infants (birthweight (BW) < or = 1250 g) with necrotising enterocolitis (NEC) with BW-matched controls. METHODS: This is a case control study performed at a regional tertiary care neonatal intensive care unit. Infants with stage II or III NEC admitted to a regional tertiary care neonatal unit between 1995 and 2000 were identified. Each infant with NEC was matched by BW (+/-100 g) to next two infants admitted in the unit without NEC. Growth and neurodevelopmental outcomes at 36 months are compared. RESULTS: In total, 51 infants with NEC and 102 controls met study eligibility criteria and 146/153 (94.3%) were prospectively followed for 36 months. Infants with NEC had more culture-proven sepsis (35.3% vs. 10.8%, P < 0.001); patent ductus arteriosus requiring therapy (64.7% vs. 45%, P = 0.02), chronic lung disease (60.7% vs. 45%, P = 0.04) and longer hospital stay (84 days vs. 71 days, P < 0.0001). There were no significant differences in growth outcomes between the two groups at 36 months. Overall 24% of infants with NEC had one major neurodevelopmental disability compared with 10% among control infants. Infants who developed NEC had significantly higher cognitive delay (i.e. cognitive index <70) and visual impairment. A logistic regression model identified NEC as a predictor of cognitive delay. CONCLUSION: Preterm infants who develop NEC are at a significantly higher risk for developing neurodevelopmental disability. We recommend close neurodevelopmental follow up for all < or =1250 g infants who develop stage II or III NEC.     

Parenteral nutrition in preterm infants: influence of respiratory treatment and effect of different amino acid compositions

Thirty-three premature infants receiving parenteral nutrition during the first 5 days of life were divided into three groups. Infants in group I (n = 13) received no ventilatory therapy. Those in groups II (n = 10) and III (n = 10) were intubated and artificially ventilated because of hyaline membrane disease, apnea, or other illness. All infants received glucose, amino acids, fat emulsion, and electrolytes in their total parenteral nutrition regimen. Groups I and II were administered a transfer-adapted amino acid solution (Aminoplasmal paed 5%) for their protein supplementation, and group III, a so-called human milk-adapted solution (Aminoven?s 6%). The three groups were compared with respect to amino acid blood level, amino acid excretion, and nitrogen balance. Taurine levels decreased significantly during parenteral nutrition in all three groups. The other amino acids, with a few exceptions, remained within acceptable range. Elevations of serine, proline, and methionine were found in group III after the third day. All three groups exhibited good nitrogen retention. Excretion of amino acids was only about 1%.     

Necrotizing enterocolitis of the neonate with Clostridium perfringens: diagnosis,clinical course,and role of alpha toxin

The severity of the clinical course in necrotizing enterocolitis (NEC) associated with Clostridium perfringens (Cp) may support the hypothesis of a specific disease. We conducted a case control study of infants diagnosed with NEC, who underwent surgical treatment over a 7-year period. Patient histories examined characteristics of the infants, bacterial infection as well as NEC’s severity, antibiotic treatment, and clinical course. Infants infected with NEC associated with Cp were compared with NEC patients without Cp. The alpha toxin from Cp type A was detected in most of the isolated strains. Cp was identified as a causative agent of NEC in nine cases. As compared with the control group (n = 32), the onset of disease was earlier in life, the clinical course more severe, and patients had a larger extent of gangrene. Portal venous gas was evident in 77% of all Cp cases, as compared to 25% in the control group. The mortality rate was 44% in the Cp group, and only 18.7% in the control group. Type A Clostridium perfringens was identified in six cases. In each isolate alpha toxin production was proven, but without any correlation to the severity of the clinical course, the extent of intestinal gangrene or mortality. In premature infants NEC in conjunction with Cp seems to be more severe than other NEC cases; it also entails higher mortality and morbidity. Alpha toxin concentrations do not correlate with the severity of the disease. Portal venous gas is highly suggestive for the diagnosis of Cp infection.     

早产极低出生体重儿肠道菌群变化与坏死性小肠结肠炎的相关性

目的:探讨早产极低出生体重儿（VLBWI）坏死性小肠结肠炎（NEC）发生前肠道菌群结构特征变化。方法:采用前瞻性巢式病例对照研究。将2018年4月20日至11月20日生后24 h内收住苏州大学附属儿童医院或苏州市立医院新生儿重症监护病房（NICU）且出生体重<1 500 g、出生胎龄<35周的46例早产VLBWI作为研...     

Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities

OBJECTIVE: To determine if the presence of a neonatal surgical facility on site has any effect on mortality and morbidity of very premature infants with necrotising enterocolitis (NEC). DESIGN AND SETTING: Retrospective review of infants of less than 29 weeks gestation cared for in the seven perinatal centres in New South Wales. PATIENTS: Between 1992 and 1997, 605 infants were cared for in two centres with in house surgical facilities (group 1) and 1195 in five centres where transfers were required for surgical management (group 2). RESULTS: Although use of antenatal steroids was significantly lower in group 1 centres than group 2 centres (74% v. 85% respectively), and the incidence of hyaline membrane disease, pneumothorax, and NEC was higher, mortality was identical (27%). Fifty two (9%) infants in group 1 and 72 (6%) in group 2 of comparable perinatal characteristics and CRIB (Clinical Risk Index for Babies) scores developed radiologically or pathologically proven NEC. The overall mortality of infants with NEC in group 1 was lower but this was not statistically significant (27% v. 35%). Significantly more infants with NEC in group 1 had surgery (69% v. 39%). There were fewer postoperative deaths in group 1 and more deaths without surgery in group 2. The duration of respiratory and nutritional support and hospital stay for the survivors were similar in the two groups. In a multivariate analysis, shorter gestation was the only factor associated with mortality in infants with NEC; the presence of in house surgical facilities was not. CONCLUSIONS: There were no significant differences in outcome of premature infants with NEC managed in perinatal centres with or without on site surgical facilities. Early transfers should be encouraged. This finding may have implications for future planning of facilities for neonatal care.     

Epidemiology of necrotizing enterocolitis--Part I: Changing regional trends in extremely preterm infants over 14 years

OBJECTIVES: Advances in perinatal care include exogenous surfactant, unequivocal acceptance of antenatal steroids and in utero and ex utero transfers to tertiary centres. Increased survival of extremely premature infants may change the incidence and outcome of necrotizing enterocolitis (NEC). Our aim was to examine the trends in the incidence of NEC, surgery and mortality in infants of 24-28 weeks gestation in a retrospective regional review of three epochs over a span of 14 years. METHODS: Radiologically or surgically proven NEC cases were determined from the New South Wales Neonatal Intensive Care Unit Study database. Three epochs were examined. A total of 360 infants were admitted in 1986-87 (Epoch 1), 622 in 1992-93 (Epoch 2) and 673 in 1998-99 (Epoch 3). RESULTS: There was an increase in neonatal intensive care unit admissions and a decrease in early and overall mortality of these very premature infants across the epochs. None of the early deaths was due to NEC. The incidence of NEC decreased in post day 5 survivors: 33 cases in Epoch 1 (12%), 60 cases in Epoch 2 (12%) and 34 cases in Epoch 3 (6%, P < 0.001). There was no change in surgical intervention (45%, 57% and 41%, respectively) or mortality due to NEC (37%, 27% and 32%). The reduced incidence of NEC was not singularly influenced by antenatal steroids, exogenous surfactant or outborn delivery. In a multivariate analysis, only later epoch of birth was independently associated with reduced NEC risk. CONCLUSIONS: With improved care and survival of extremely premature infants, the incidence of NEC has decreased, but it remains a disease of high mortality and morbidity.     

A randomized, controlled trial of parenteral clindamycin in neonatal necrotizing enterocolitis

For an assessment of the efficacy of clindamycin in preventing bowel necrosis (intestinal gangrene or perforation), 42 premature infants with radiographically confirmed necrotizing enterocolitis (NEC) (pneumatosis, intraportal gas, or both) were randomly assigned to receive parenterally either ampicillin and gentamicin (control group, n = 22) or ampicillin, gentamicin, and clindamycin (n = 20), 20 mg/kg/d at 8-hour intervals for 10 to 14 days. Infants who had received antibiotics for greater than 24 hours before randomization and those developing intestinal gangrene or perforation less than 12 hours after randomization were excluded. Intestinal gangrene or perforation developed in four infants in the control group and six in the clindamycin group. Four in each group died of NEC. In the control group, one of 18 survivors developed a late stricture requiring surgical resection, whereas six of 15 survivors in the clindamycin group developed such strictures (P = 0.022). Routine inclusion of clindamycin in medical treatment of NEC does not reduce the frequency of intestinal gangrene or perforation and may be associated with an increase in late stricture formation.     

Catabolic effect in premature infants with early dexamethasone treatment

To evaluate the catabolic effects of dexamethasone therapy on protein metabolism, amino acid concentrations and urinary 3-methylhistidine (3MH) were measured in 28 premature infants who were included in a double-blind controlled study using early dexamethasone therapy in the prevention of bronchopulmonary dysplasia. Fifteen infants received dexamethasone (0.5mg/kg/day i.v.) and 13 infants received normal saline as control. Heparinized venous blood samples for amino acid analysis were obtained before the study and again at day 5 after starting the study. Urinary 3MH was measured on days 1, 3, 5, 7, 14, 21, and 28 of treatment. A substantial increase in amino acid concentrations was observed in infants receiving dexamethasone. Alanine, glutamine, citrulline, ornithine and cystine concentrations increased twofold or more. The 3MH:creatinine ratio was increased in the treated group. These metabolic effects were most likely due to an increase in protein catabolism.     

Necrotizing enterocolitis in a perinatal centre

Thirty-five neonates developed radiologically proven necrotizing enterocolitis (NEC) over a 40 month period. They were 28 +/- 2 weeks gestation, and weighted 1094 +/- 411 g at birth. Eighteen infants (51%) required surgery and three (8.5%) died. The incidence was 6.7% in the very low birthweight (VLBW) infants. A large proportion of NEC (60%) presented beyond 10 days of life. An inverse relationship between gestation and age of onset was observed. The age of presentation was 22 +/- 13 days (range 10-53 days) for the 18 infants less than or equal to 28 weeks compared with 7 +/- 5 days for those over 28 weeks (P less than 0.01). Five NEC infants had bacteraemia which occurred 2-7 days prior to gastrointestinal symptoms of NEC, and four were staphylococcal. Compared with infants controlled for gestation, there was no significant differences observed in perinatal events or feeding history. We concluded that an immature gastrointestinal system is vulnerable to NEC even beyond the early neonatal period.     

Increased parenteral amino acid administration to extremely low-birth-weight infants during early postnatal life

BACKGROUND: Early administration of parenteral amino acids to infants with extremely low birth weight (birth weight < or = 1,000 g) has been encouraged to foster growth. However, excessive intravenous intake of amino acids may cause metabolic acidosis and uremia in extremely low birth weight infants. The hypothesis for this study was that extremely low birth weight infants would tolerate slightly increased early postnatal parenteral amino acid administration and benefit. METHODS: The peak daily parenteral amino acid dosage was increased from 3 g/kg (standard group) to 4 g/kg (modified group). The corrected parenteral amino acid dosage was computed to account for enteral protein intake and keep the combined daily intravenous amino acid and enteral protein intake at or below 3 g . kg -1 . d -1 in the standard group and 4 g . kg -1 . d -1 in the modified group. The primary outcome measure was plasma bicarbonate concentration as an indicator of acid-base status. Data were collected for patient demographics, nutritional intake, serum bicarbonate and serum urea nitrogen concentrations, and outcome. RESULTS: The corrected parenteral amino acid intake of the modified group was 16% greater at postnatal week 1 (3.30 +/- 0.83 g . kg -1 . d -1; mean, +/-1 SD) and 18% greater (3.86 +/- 0.94 g . kg -1 . d -1 ) at postnatal week 2 than the parenteral amino acid intake of the standard group. In the modified group, the mean serum bicarbonate concentration was 19.1 +/- 1.8 mEq/dL at week 1 and 23.9 +/- 2.9 mEq/dL at week 2, with no difference between the groups. At week 1, serum urea nitrogen concentrations were the same in both groups. The mean serum urea nitrogen concentration of the modified group at postnatal week 2 (18.2 +/- 8.8 mg/dL) was unchanged from postnatal week 1, but was greater than that of the standard group at postnatal week 2. Weight gain was the same in both groups. Corrected parenteral amino acid intake at postnatal week 1 correlated directly with weight gain from birth to postnatal week 2 ( P < 0.03) in both groups. CONCLUSIONS: Infants with extremely low birth weight tolerated parenteral amino acid intake of approximately 4 g . kg -1 . d -1. Mild increases of mean serum urea nitrogen concentration and mean weight gain were associated with increased parenteral amino acid administration without significant acidosis.     

Carbamoyl phosphate synthetase polymorphisms as a risk factor for necrotizing enterocolitis

A C-to-A nucleotide transversion (T1405N) in the gene that encodes carbamoyl-phosphate synthetase 1 (CPS1) has been correlated with low plasma concentrations of L-arginine in neonates. As plasma L-arginine concentrations are decreased in premature infants with necrotizing enterocolitis (NEC), we hypothesized that the CPS1 T1405N polymorphism would correlate with the presence of NEC. We analyzed the CPS1 genotypes for the T1405N polymorphism in 17 preterm infants (相似文献   

Necrotizing enterocolitis in infants with esophageal atresia awaiting delayed primary repair

Of 149 infants with esophageal atresia treated during a 13-year period, 5 (3%) developed postoperative necrotizing enterocolitis (NEC). Four of the 5 were premature with birth weights below 1.8 kg (Waterston group C), and all were from a group of 17 awaiting delayed primary esophageal anastomosis. In each case, NEC occurred suddenly and death ensued within 5 days. NEC should be included in the list of complications resulting from, or associated with, delayed primary repair of esophageal atresia.     

Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation

AIM: To determine whether patient triggered ventilation (PTV) leads to greater exposure to significant hypocarbia than conventional ventilation (CMV) in premature infants during the first 72 hours of life. METHODS: Infants of 32 weeks gestation or less were included. Randomisation yielded 74 infants on PTV and 68 infants on CMV. Arterial PaCO(2) measurements were taken four hourly for the first 72 hours of life. RESULTS: The mean PaCO(2) levels on days 1, 2, and 3 were not significantly different between the two groups. The proportion of infants with PaCO(2) levels of 3.33 kPa or less did not differ between PTV and CMV infants. Mean percentages of infants with this level of hypocarbia at any time were 31.4%, 18.9%, 8.8% on days 1, 2, and 3 respectively. Cumulative hypocarbia, below a 3.33 kPa threshold, was 0.0084 kPa.h (PTV) versus 0.0263 kPa.h (CMV) per hour ventilated during the first 24 hours (p = 0.259). Risk factors associated with hypocarbia on day 1 were peak inspiratory pressure below 14 cm H(2)O (odds ratio 4.79) as well as FiO(2) below 0.30 (odds ratio 3.42). CONCLUSION: Exposure to hypocarbia (PaCO(2) 3.33 kPa or below) was not significantly different between PTV and CMV infants during the first 72 hours of life. Hypocarbia was common in both groups on day 1 and to a lesser extent on day 2. Infants with the least requirements for ventilatory support were at highest risk of hypocarbia on day 1 of life. Preterm infants with mild hyaline membrane disease require a more aggressive approach to weaning on both modes of ventilation, followed by extubation to limit the risk of hypocarbia.     

The preterm gut microbiota: changes associated with necrotizing enterocolitis and infection

Aim: To describe gut colonization in preterm infants using standard culture and 16S gene rRNA profiling, exploring differences in healthy infants and those who developed NEC/late onset sepsis (LOS). Methods: Ninety‐nine stools from 38 infants of median 27‐week gestation were cultured; 44 stools from 27 infants had their microbial profiles determined by 16S. Ordination analyses explored effects of patient variables on gut communities. Results: Standard microbiological culture identified a mean of two organisms (range 0–7), DGGE 12 (range 3–18) per patient. Enterococcus faecalis and coagulase negative staphylococci (CONS) were most common by culture (40% and 39% of specimens). Meconium was not sterile. No fungi were cultured. Bacterial community structures in infants with NEC and LOS differed from healthy infants. Infants who developed NEC carried more CONS (45% vs 30%) and less Enterococcus faecalis (31% vs 57%). 16S identified Enterobacter and Staphylococcus presence associated with NEC/LOS, respectively. Conclusions: Important differences were found in the gut microbiota of preterm infants who develop NEC/LOS. The relationship of these changes to current practices in neonatal intensive care requires further exploration.     

Human torovirus: a new virus associated with neonatal necrotizing enterocolitis

AIM: Toroviruses have been associated with gastroenteritis in both animals and humans. The aim of this study was to examine the fecal excretion of torovirus in infants with necrotizing enterocolitis (NEC). METHODS: We reviewed all infants with NEC admitted to our tertiary care NICU over a 5-y period who had stool specimens sent for microbial culture and virology. Infants in the NICU during the same period with diagnoses other than NEC served as controls. RESULTS: Forty-four infants with NEC stages I-III were identified, and pathogenic organisms were identified in 27 (61%). Toroviruses were identified in stool cultures in 48% of patients with NEC, and 17% of the non-NEC controls (p<0.001). There was no significant difference in illness severity or mortality between the torovirus-positive and -negative infants with NEC. CONCLUSION: Torovirus should be added to the list of infectious agents associated with NEC in newborn infants. The exact role torovirus plays in the etiology and progression of NEC warrants further investigation.     

Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants

OBJECTIVE: To determine whether the rate of feed advancement affects the incidence of necrotizing enterocolitis (NEC). STUDY DESIGN: Prospective randomized controlled trial involving 185 formula-fed infants with birth weight 501 to 1500 g and gestational age /=II) was similar in both groups (slow 13% and fast 9%, P =.5). The incidence of perforation (Bell stage III) was also similar in both groups (slow 4% and fast 2%, P =.8). Feeds were started at a comparable postnatal age in both groups (median age: slow 5 days and fast 4 days, P =.9). Although the neonates in the fast group attained full enteral intake earlier (median days [25th and 75th percentiles]: slow 15 [12, 21] and fast 11 [8, 15], P <.001) and regained their birth weight earlier (slow 15 [11, 20] and fast 12 [8, 15], P <.05), their ages at discharge were not statistically different (slow 47 [31, 67] and fast 43 [29, 62], P =.3) CONCLUSIONS: A greater than twofold difference in the rate of feed advancement from 15 cc/kg/d to 35 cc/kg/d did not affect the incidence of NEC >/= stage II. Factors other than feed advancement appear to be more important in the pathogenesis or progression of NEC.     

Rehospitalization of extremely-low-birth-weight infants in first 2 years of life

AIMS: To determine whether (1) chronic lung disease (CLD) is the prime reason for extremely-low-birth-weight (ELBW) infant readmission during the first 2 years of life, (2) surfactant and other advanced therapies have reduced ELBW infant readmissions, (3) home oxygen therapy (HOT) is efficacious for this group. STUDY DESIGN: The hospital records of these ELBW infants were reviewed retrospectively. Data on age, diagnosis, treatment, and duration of each hospitalization were compiled and analyzed for their association to CLD and to readmission for CLD and other reasons. SUBJECTS: All 60 surviving infants with a birth body weight of less than 1001 g (ELBW) born from January 1993 to February 1998 were followed up to 2 years (mean 20.4 +/- 7.4 months) to evaluate their respiratory outcome. RESULTS: Forty-two percent of these infants developed CLD. Upon discharge from the hospital, 28% (7/25) of the patients were given HOT for a median period of 60 days. Of the 47 ELBW infants who were studied the entire 2-year period, 72% were readmitted. Infants with CLD were readmitted more frequently (p=0.045) and had longer hospital stays during the first 2 years of life (p=0.034) than those without CLD. Respiratory illness was the main reason for readmission (55%) of these ELBW infants. The incidence of readmission due to respiratory tract infection was not significantly different in infants with CLD (61%) and infants without respiratory complications (44%) (p=0.159). CONCLUSIONS: Infants with CLD (whether receiving HOT or not) showed no higher readmission rate due to respiratory infection, but the HOT group did have higher morbidity. The premature lung itself rather than the presence of CLD, as we would expect, makes ELBW infants more prone to readmission for respiratory illness.     

新生儿坏死性小肠结肠炎血浆肠脂肪酸结合蛋白水平变化的意义

目的 探讨血浆肠脂肪酸结合蛋白（I-FABP）水平变化在指导新生儿坏死性小肠结肠炎（NEC）诊断及治疗中的意义.方法 选择2011年5月至2012年12月我院新生儿科收治的患儿,按入院先后顺序,以明确诊断NEC的50例新生儿为NEC组,其中NECⅡ期30例,NECⅢ期20例,以非NEC新生儿50例为对照组.NEC组在确诊后24 h内、对照组在相应日龄取血,采用酶联免疫吸附法（ELISA）检测血浆I-FABP水平,根据NEC患儿病情转归分为存活组及病死组,按治疗方法分为保守治疗组和手术治疗组,比较不同组间血浆I-FABP水平、新生儿危重病例评分（NCIS）分值、脓毒症的发生率及病死率.结果 NECⅡ期组、NECⅢ期组和对照组血浆I-FABP水平分别为（95.6±18.5） μmol/L、（151.2±10.8）μmol/L和（1.2±2.3）μmol/L,组间比较差异有统计学意义（P＜0.05）;NECⅡ期组和NECⅢ期组NCIS评分明显低于对照组,脓毒症发生率和病死率均高于对照组,差异有统计学意义（P＜0.05）,NECⅡ期组和NECⅢ期组差异无统计学意义（P＞0.05）.病死组血浆I-FABP水平、脓毒症发生率高于存活组,NCIS评分低于存活组;保守治疗组I-FABP水平低于手术治疗组,NCIS评分高于手术治疗组,差异均有统计学意义（P＜0.05）.结论 血浆I-FABP水平可较敏感地反映NEC患儿的病情变化,可作为预测NEC病情严重程度及指导采取内外科治疗的指标之一.