Neonatal necrotizing enterocolitis (NEC) is a leading cause of death in neonates, especially in preterm infants. Sepsis is a common and severe complication after NEC onset. This study aims to evaluate the characteristics of sepsis development in NEC patients and to explore the association between sepsis and clinical outcomes of NEC.

This case-control study enrolled 178 neonates diagnosed with NEC admitted in our hospital from April 2022 to December 2023, who were matched 1:1 with 178 non-NEC controls by birth weight, gestational age, and sex. All neonates were grouped according to the presence or absence of sepsis. Univariate analysis and stepwise-adjusted multivariate logistic regression were used to analyze risk factors for sepsis. The impact of sepsis on clinical outcomes in NEC patients was analyzed.

The NEC group exhibited significantly older maternal gestational age (P<0.001) and a higher prevalence of congenital heart disease (P<0.02) compared with the control group. Among the 356 neonates, 120 developed sepsis. Univariate analysis indicated that younger gestational age, lower birth weight, 5-minute Apgar score≤7, and NEC were potentially associated with sepsis (all P<0.05). Univariate logistic regression analysis showed that NEC was a risk factor for sepsis (OR=2.042, 95%CI: 1.307 to 3.213, P=0.002). Stepwise-adjusted multivariate logistic regression analysis showed that after adjusting for gestational age, birth weight, and 5-min Apgar score, NEC remained a significant risk factor for sepsis (OR=2.141, 95%CI: 1.345 to 3.436, P=0.001). Among the NEC neonates, those with sepsis had a significantly higher surgical rate (52.70% vs 14.42%, P<0.001) and an increased mortality rate (22.97% vs 6.73%, P=0.002) than those without sepsis.

NEC significantly increases the risk of sepsis and leads to more adverse clinical outcomes. These findings suggest that NEC patients may require enhanced early identification and monitoring of sepsis to improve their clinical outcomes.

To investigate the relationship between the development of terminal rectal ganglion and spinal cord/sacral abnormalities in boys with complex anorectal malformations (ARMs) in order to improve the understanding of rectal ganglion development abnormalities in ARMs patients.

A retrospective trial was conducted on the male patients with complex ARMs admitted to our hospital from 2015 to 2021. The terminal rectal specimens were taken from them during anoplasty. According to the findings on development of terminal rectal ganglion after HE staining, the patients were classified into G1 group (ganglion cells observed) and G2 group (no ganglion cells observed). Imaging techniques were used to evaluate whether there were abnormalities in the spinal cord and sacrum, and their correlation with the terminal rectal ganglion development was analyzed.

A total of 139 patients were enrolled, and their median age at anoplasty was 5.77 (4.57, 6.97) months. There were no significant differences between the G1 (n=80, 57.6%) and G2 (n=59, 42.4%) groups in ARMs pathological type (P=0.706) and age at surgery (P=0.140). Radiological findings showed there were 48 cases (34.5%) of spinal cord anomalies (SCA), 25 cases (18.0%) of sacral abnormalities and 18 cases (12.9%) of coccyx abnormalities. No significant differences were observed in the incidences of SCA and sacral abnormalities between the G1 and G2 groups (P<0.05). Moreover, the differences of fatty filum terminale and syrinx were statistically significant (P<0.05). In addition, the ratio of sacrum to coccyx between the G1 and G2 groups were 0.72±0.10 vs 0.67±0.12 (P<0.05) of the anteroposterior position and 0.77±0.09 vs 0.72±0.09 (P<0.05) of the lateral position. Multivariate logistic regression analysis showed that sacral abnormalities, fatty filum terminale and syrinx were independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.

The development of terminal rectal ganglia in male patients with ARMs is closely associated with the abnormalities of spinal cord and sacrum. Sacral abnormalities, fatty filum terminale and syrinx are independent predictors of rectal terminal ganglion absence in male patients with complex ARMs.

To compare the diagnostic efficacy of ultrasound and inverted X-ray in differentiating high and intermediate types of male anorectal malformations（ARMs）.

A fully paired diagnostic accuracy study was conducted on 146 male children with intermediate/high type ARMs who were treated in our hospital from March 2013 to March 2022. According to their postoperative diagnosis after anorectal plasty, 55 cases（including 12 with bladder-neck fistula and 43 with urethral-prostatic fistula）were assigned into high type group and 91 cases（including 65 with urethral-bulbar fistula and 26 without fistula）into intermediate type group. The accuracy, sensitivity, specificity, and area under the curve（AUC）were used as evaluation indicators to compare the diagnostic efficacy of 2 examinations and the optimal diagnostic cutoff values by receiver operating characteristic（ROC）curve analysis. And the diagnostic efficacy of ultrasound and inverted X-ray was then compared in different time periods after birth.

Both examinations effectively differentiated high and intermediate types of male ARMs（P<0.05）. The ROC curve analysis showed that the AUC of ultrasound（0.835, 95%CI: 0.764~0.891）was higher than that of inverted X-ray（0.759, 95%CI: 0.681~0.826）, though without significant difference（P=0.061）. The cut-off value of ultrasound（15.0 mm）was shorter than that of inverted X-ray（24.0 mm）. The diagnostic efficacy of ultrasound（0.940, 95%CI: 0.799~0.993）was significant higher than that of inverted X-ray（0.758, 95%CI: 0.578~0.890）when inspection time was longer than 48 h after birth（P=0.032）.

Both ultrasound and inverted X-ray can differentiate intermediate and high type ARMs in male neonates. Ultrasound is more recommended for the neonates older than 48 h.