Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study

Autor: Marcus T. R. Roofthooft, Martin van der Heide, Arend F. Bos, Jan B F Hulscher, Rolf M. F. Berger, Mirthe J Mebius, Elisabeth M. W. Kooi
Přispěvatelé: Reproductive Origins of Adult Health and Disease (ROAHD), Cardiovascular Centre (CVC), Center for Liver, Digestive and Metabolic Diseases (CLDM)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Heart Defects
Congenital
medicine.medical_specialty
Neonatal intensive care unit
Heart disease
ischemic hits
Transposition of Great Vessels
BLOOD-PRESSURE
03 medical and health sciences
0302 clinical medicine
Enterocolitis
Necrotizing
Ischemia
Risk Factors
Necrotizing enterocolitis
030225 pediatrics
Internal medicine
medicine
Humans
030212 general & internal medicine
Apgar score
Pneumatosis intestinalis
Hypoxia
PREMATURE-INFANTS
Retrospective Studies
RISK
PRETERM
business.industry
hypoxic/ischemic hits
lcsh:RJ1-570
Infant
Newborn
diastolic blood pressure
Gestational age
Infant
lcsh:Pediatrics
hypoxic
medicine.disease
congenital heart disease
digestive system diseases
(near) term infants
Blood pressure
Great arteries
Case-Control Studies
Pediatrics
Perinatology and Child Health
Cardiology
medicine.symptom
business
Research Article
Zdroj: BMC Pediatrics, 20(1):553. BMC
BMC Pediatrics
BMC Pediatrics, Vol 20, Iss 1, Pp 1-8 (2020)
ISSN: 1471-2431
Popis: BackgroundNecrotizing enterocolitis (NEC) is a devastating disease that is relatively frequently diagnosed in term infants with congenital heart disease (CHD), compared with term infants without CHD, in whom NEC is rare. The exact pathogenesis of NEC in term infants with CHD is unknown, but it is hypothesized that ischemia of the intestines plays a pivotal role. We aimed to explore whether (near) term CHD infants, who develop NEC, exhibit more clinical signs of hypoxia/ischemia and low body perfusion directly after birth and during the first 48 hours after admission to the neonatal intensive care unit, when compared with (near) term CHD infants who did not develop NEC.Methods956 infants with CHD born after ≥ 35 weeks of gestational age were retrospectively reviewed for this case-control study between January 1999 and February 2020. We included infants with radiographically confirmed pneumatosis intestinalis and controls matched by type of CHD. Seven infants were diagnosed with transposition of the great arteries, six with left and four with right ventricular outflow tract obstruction. Several parameters suggestive of (relative) hypoxia/ischemia were used for analyses.ResultsWe included sixteen CHD infants with NEC and selected sixteen controls. There were no significant demographic differences between both groups. Apgar score at one and five minutes (median [IQR]) were lower in infants who developed NEC compared with control infants (8 [7-8]) vs. (9 [8-9],P = .011) and (8 [8-9]) vs. (9 [9-10],P = .009). A higher proportion of infants with NEC required respiratory support in the delivery room (11(69) vs. 2(13),P = .001). The (median [IQR]) diastolic blood pressure on the second day after admission (39 mmHg [34–42], vs. 43 mmHg [37–51],P = .112) and lowest (median [IQR]) pH in the 48 hours after admission (7.24 [7.17–7.35] vs. 7.38 ([7.27–7.43],P = .157) were not significantly lower in NEC infants but both demonstrated a similar direction towards (relative) hypoxia/ischemia in NEC infants.ConclusionsOur clinical results support a hypoxic/ischemic pathophysiology of NEC in (near) term CHD infants, with lower Apgar scores, more respiratory support in the delivery room and a tendency towards a lower diastolic blood pressure and pH in CHD infants who develop NEC.
Databáze: OpenAIRE
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