Becker Kristian C, Hornik Christoph P, Cotten C Michael, Clark Reese H, Hill Kevin D, Smith P Brian, Lenfestey Robert W
Duke Clinical Research Institute, Durham, North Carolina.
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
Am J Perinatol. 2015 Jun;32(7):633-8. doi: 10.1055/s-0034-1390349. Epub 2014 Dec 8.
Infants with congenital heart disease (CHD) receiving prostaglandins (PGEs) may be at an increased risk for necrotizing enterocolitis (NEC). Enteral feeding may further increase the risk of NEC in these patients. We evaluated the incidence of NEC and its association with enteral feeding in infants with ductal-dependent CHD.
We examined a cohort of infants with CHD receiving PGE in neonatal intensive care units managed by the Pediatrix Medical Group (Sunrise, FL) between 1997 and 2010. We used logistic regression to evaluate the association between NEC and enteral feeding, as well as other risk factors, including antacid medications, inotropic and ventilator support, and anatomic characteristics, controlling for gestational age.
We identified 6,710 infants with ductal-dependent CHD receiving PGE for 17,158 infant days. NEC occurred in 21 of the 6,710 (0.3%) infants, of whom 12/21 (57%) were < 37 weeks gestational age. The incidence of NEC was 1.2/1,000 infant days while on enteral feeds versus 0.4/1,000 infant days while not on enteral feeds (p = 0.27). Enteral feeding was not associated with a statistically significant increased odds of NEC on the day of diagnosis (odds ratio [OR] 2.08; 95% confidence interval [CI] 0.38, 11.7). Risk factors associated with a significant increased odds of NEC included a diagnosis of single-ventricle heart defect (OR 2.82; 95% CI 1.23, 6.49), although the overall risk in this population remained low (8/1,631, 0.5%).
The incidence of NEC in our cohort of infants with ductal-dependent CHD on PGE therapy was low and did not increase with enteral feeding.
患有先天性心脏病（CHD）且接受前列腺素（PGEs）治疗的婴儿发生坏死性小肠结肠炎（NEC）的风险可能会增加。肠内喂养可能会进一步增加这些患者发生NEC的风险。我们评估了导管依赖性CHD婴儿中NEC的发生率及其与肠内喂养的关系。
我们对1997年至2010年间在Pediatrix医疗集团（佛罗里达州日出市）管理的新生儿重症监护病房接受PGE治疗的CHD婴儿队列进行了研究。我们使用逻辑回归来评估NEC与肠内喂养之间的关联，以及其他风险因素，包括抗酸药物、强心和通气支持以及解剖特征，并对胎龄进行了控制。
我们确定了6710例导管依赖性CHD婴儿，共接受了17158个婴儿日的PGE治疗。6710例婴儿中有21例（0.3%）发生了NEC，其中12/21（57%）胎龄小于37周。肠内喂养时NEC的发生率为1.2/1000婴儿日，未进行肠内喂养时为0.4/1000婴儿日（p = 0.27）。在诊断当天，肠内喂养与NEC发生几率的统计学显著增加无关（优势比[OR] 2.08；95%置信区间[CI] 0.38，11.7）。与NEC发生几率显著增加相关的风险因素包括单心室心脏缺陷的诊断（OR 2.82；95% CI 1.23，6.49），尽管该人群中的总体风险仍然较低（8/1631，0.5%）。
在我们接受PGE治疗的导管依赖性CHD婴儿队列中，NEC的发生率较低，且不会因肠内喂养而增加。
