University Medical Center Groningen, Department of Surgery, Division of Paediatric Surgery, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
University Medical Center Groningen, Department of Paediatrics, Division of Neonatology, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
J Pediatr Surg. 2019 Sep;54(9):1755-1760. doi: 10.1016/j.jpedsurg.2018.11.012. Epub 2018 Dec 13.
Necrotizing enterocolitis (NEC) predominantly occurs in preterm infants (PT-NEC). In term neonates, NEC occurs more frequently when a congenital heart disease is present (CHDNEC). Our aim was to evaluate differences and similarities in disease characteristics of PT-NEC versus CHD-NEC.
In this retrospective case-control study we identified all CHD infants who developed NEC Bell's stage ≥2 in our center from 2004 to 2014. We randomly selected (1:2 ratio) PT-NEC infants from the same period. Biochemical and clinical variables were retrieved from patient files.
We found 18 CHD-NEC infants and selected 36 PT-NEC infants (gestational age 28.3 [25-35.6] weeks vs. 38.6 [31.7-40.7] weeks). Postnatal age at onset was significantly lower in CHD-NEC patients (4 [2-24] vs. 11 [4-41] days, p < 0.001). Lowest pH levels were lower (7.21 [7.01-7.47] vs. 7.27 [6.68-7.39], p = 0.02), and highest CRP levels were higher (112.5 mg/L [5.0-425.0] vs. 66.0 [5.2-189.0], p = 0.05) in PT-NEC vs. CHD-NEC. Anatomic localisation of the disease differed: the colon was significantly more often involved in CHD-NEC versus PT-NEC (86% vs. 33%, p = 0.03). Mortality caused by NEC was not different (22% vs. 11%, p = 0.47).
While outcome of NEC in both groups is similar, the predominant NEC localisation differed between CHD-NEC and PT-NEC patients. This suggests that both variants of the disease have a different underlying pathophysiological mechanism that predisposes different intestinal regions to develop NEC.
Retrospective Case-Control Study.
Level III.
坏死性小肠结肠炎（NEC）主要发生在早产儿（PT-NEC）中。在足月新生儿中，当存在先天性心脏病（CHDNEC）时，NEC 更常发生。我们的目的是评估 PT-NEC 与 CHD-NEC 之间疾病特征的差异和相似之处。
在这项回顾性病例对照研究中，我们从 2004 年至 2014 年确定了在我们中心发生了 NEC Bell 分期≥2 的所有 CHD 婴儿。我们从同一时期随机选择（1:2 比例）PT-NEC 婴儿。从病历中检索生化和临床变量。
我们发现了 18 例 CHD-NEC 婴儿，并选择了 36 例 PT-NEC 婴儿（胎龄 28.3 [25-35.6] 周 vs. 38.6 [31.7-40.7] 周）。CHD-NEC 患者的发病后天数明显较低（4 [2-24] 天 vs. 11 [4-41] 天，p<0.001）。最低 pH 值较低（7.21 [7.01-7.47] vs. 7.27 [6.68-7.39]，p=0.02），CRP 最高水平较高（112.5 mg/L [5.0-425.0] vs. 66.0 [5.2-189.0]，p=0.05）PT-NEC 与 CHD-NEC。疾病的解剖定位不同：CHD-NEC 中结肠明显更常受累（86% vs. 33%，p=0.03）。NEC 引起的死亡率无差异（22% vs. 11%，p=0.47）。
尽管两组 NEC 的结局相似，但 CHD-NEC 和 PT-NEC 患者的主要 NEC 定位不同。这表明这两种疾病变体具有不同的潜在病理生理机制，使不同的肠道区域易发生 NEC。
回顾性病例对照研究。
III 级。
