与新生儿坏死性小肠结肠炎相关的母亲危险因素：一项荟萃分析和系统综述。
完整摘要 · 中文译文
背景：新生儿坏死性小肠结肠炎（NEC）是一种多因素肠道疾病，影响2-5%的早产儿，死亡率为20-30%。已发现母乳喂养和产前糖皮质激素治疗等母亲因素会影响婴儿NEC的发生，但其他母亲和围产期影响因素尚未得到详细分析。更好地了解特定母亲因素在NEC发生中的作用有助于识别高危婴儿。本meta分析旨在研究剖宫产分娩、吸烟、子痫前期、绒毛膜羊膜炎、糖尿病和母亲受教育程度与NEC发生之间的合并关联。 方法：我们系统检索了2025年4月之前发表在Springer Nature Link、Scopus、PubMed和Google Scholar上的期刊文章。使用布尔检索字符串（“necrotizing enterocolitis” OR “neonatal necrotizing enterocolitis”）AND（（“maternal risk” OR “maternal factors”）OR（“smoking” OR “preeclampsia” OR “chorioamnionitis” OR “diabetes”））缩小结果范围。如果研究报告了任何所考察因素的NEC发生率，则纳入研究。两名评价者独立筛选和提取文献，分歧通过讨论解决。评价者间信度使用Cohen's Kappa评估。 结果：我们确定了74篇符合纳入标准的手稿，其中26篇适合我们的meta分析。我们从提取的2×2数据计算未调整OR，因为调整后的估计值很少报告且为 未合并。未校正的合并风险计算显示，先兆子痫（OR：2.11，95% CI：1.15-3.06，n = 4）和妊娠期吸烟（OR：1.97，95% CI：1.66-2.28，n = 6）均与NEC的较高发生风险相关。漏斗图和Egger回归检验表明，对于研究数超过10项的母体因素，无发表偏倚的证据。 结论：本研究强调了妊娠期母亲吸烟和先兆子痫与NEC发生之间存在显著的合并未校正关联。尽管其他研究提出了相互矛盾的主张，但在此合并未校正分析中，绒毛膜羊膜炎和剖宫产本身与NEC并无显著关联。本荟萃分析强调需要进行更多研究，以分析母亲吸烟、先兆子痫、剖宫产、绒毛膜羊膜炎和母亲教育程度与NEC发生之间的关联。
完整摘要 · 英文原文
BACKGROUND: Neonatal Necrotizing Enterocolitis (NEC) is a multifactorial intestinal disorder that affects 2-5% of premature infants and has a mortality rate of 20-30%. Maternal factors such as breastmilk feeding and antenatal corticosteroid therapy have been found to influence NEC development in infants, yet other maternal and perinatal contributors have not been analyzed in detail. A better understanding of the role of specific maternal factors in NEC development can help identify infants at risk. This meta-analysis aims to investigate the pooled association between Cesarean section delivery, smoking, preeclampsia, chorioamnionitis, diabetes mellitus, and maternal education on the development of NEC. METHODS: We systematically searched for journal articles published before April 2025 in Springer Nature Link, Scopus, PubMed, and Google Scholar. Results were narrowed down using the Boolean search string ("necrotizing enterocolitis" OR "neonatal necrotizing enterocolitis") AND (("maternal risk" OR "maternal factors") OR ("smoking" OR "preeclampsia" OR "chorioamnionitis" OR "diabetes")). Studies were included if they reported NEC incidence rates for any of the examined factors. Two evaluators independently screened and extracted literature, and disagreements were resolved through discussion. Interrater reliability was assessed using Cohen's Kappa. RESULTS: We identified 74 manuscripts that met the inclusion criteria, of which 26 were suitable for our meta-analysis. We calculated unadjusted ORs from extracted 2 × 2 data, as adjusted estimates were infrequently reported and were not pooled. The unadjusted pooled risk calculation showed a higher odds of NEC for both preeclampsia (OR: 2.11, 95% CI: 1.15-3.06, n = 4) and smoking during pregnancy (OR: 1.97, 95% CI: 1.66-2.28, n = 6). Funnel plots and Egger's regression tests indicated no evidence of publication bias for maternal factors with more than 10 studies. CONCLUSIONS: This study highlights a significant pooled unadjusted association between maternal smoking and preeclampsia during pregnancy and the development of NEC. Chorioamnionitis and Cesarean sections alone were not significantly associated with NEC in this pooled unadjusted analysis, despite conflicting claims from other studies. This meta-analysis underscores the need for more research to be conducted to analyze the association between maternal smoking, preeclampsia, Cesarean sections, chorioamnionitis, and maternal education on the development of NEC.