Kessler Ulf, Hau Eva-Maria, Kordasz Marcin, Haefeli Stephanie, Tsai Catherine, Klimek Peter, Cholewa Dietmar, Nelle Mathias, Pavlovic Mladen, Berger Steffen
Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Center of Visceral Surgery, Bern, Switzerland.
Front Pediatr. 2018 Oct 23;6:312. doi: 10.3389/fped.2018.00312. eCollection 2018.
Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes. We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension ( = 45) and compared outcomes of patients with hemodynamically relevant CHD ( = 38) and those without CHD ( = 91). Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5-37.2w, vs. 32.6, 31.9-33.3w; < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3-39.5 for CHD, and of 3.4, 1.6-7.5 for stage III disease. While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD.
关于先天性心脏病（CHD）对坏死性小肠结肠炎（NEC）新生儿影响的研究结果各异。因此，我们研究了CHD对NEC预后的影响。我们进行了一项回顾性单中心研究，纳入了2004年至2017年间确诊为NEC并接受治疗的婴儿。我们排除了单纯动脉导管未闭或肺动脉高压患者（n = 45），并比较了有血流动力学相关CHD患者（n = 38）和无CHD患者（n = 91）的预后。患有CHD的患者比没有CHD的患者更成熟[胎龄，中位数，95%置信区间（CI95），37.1，34.5 - 37.2周，对比32.6，31.9 - 33.3周；P < 0.01]。CHD的存在并不影响严重疾病的发生率（总体21%为Bell III期）、手术干预率（总体30%）、肠道并发症的发生率（总体13%）以及住院时间（幸存者总体为38天）。CHD患者的总体死亡率以及与NEC相关的死亡率均有所增加，分别为50%（38例中的19例）和13%（38例中的5例），而无CHD患者的死亡率分别为8%（91例中的7例）和3%（91例中的3例）。CHD的存在和NEC晚期III期是NEC相关死亡的独立预测因素，多变量优势比（CI95）对于CHD为7.0，1.3 - 39.5，对于III期疾病为3.4，1.6 - 7.5。虽然NEC新生儿的一些预后参数不受CHD存在的影响，但患有CHD的患者的死亡风险比没有CHD的患者高七倍。
