Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Division of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
BMC Pediatr. 2020 Dec 7;20(1):553. doi: 10.1186/s12887-020-02446-6.
Necrotizing 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.
956 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.
We 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.
Our 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.
坏死性小肠结肠炎（NEC）是一种破坏性疾病，与无先天性心脏病（CHD）的足月婴儿相比，患有 CHD 的足月婴儿相对更常被诊断出患有 NEC，而无 CHD 的足月婴儿则很少发生 NEC。患有 CHD 的足月婴儿发生 NEC 的确切发病机制尚不清楚，但据推测，肠道缺血起关键作用。我们旨在探索在新生儿重症监护病房（NICU）入院后最初 48 小时内，与未发生 NEC 的患有 CHD 的（近）足月婴儿相比，患有 NEC 的（近）足月 CHD 婴儿在出生后和出生后直接是否表现出更多的缺氧/缺血和低全身灌注的临床体征。
本病例对照研究回顾性分析了 1999 年 1 月至 2020 年 2 月期间出生胎龄≥35 周的 956 名 CHD 婴儿的资料。我们纳入了经影像学证实有肠积气的婴儿，并按 CHD 类型进行配对对照。7 例诊断为大动脉转位，6 例左心室流出道梗阻，4 例右心室流出道梗阻。使用了几种提示（相对）缺氧/缺血的参数进行分析。
我们纳入了 16 例患有 NEC 的 CHD 婴儿，并选择了 16 名对照婴儿。两组之间在人口统计学上没有显著差异。与对照组婴儿相比，发生 NEC 的婴儿出生后 1 分钟和 5 分钟的 Apgar 评分较低（中位数[IQR]）（8[7-8]与 9[8-9]，P=0.011）和（8[8-9]与 9[9-10]，P=0.009）。需要在分娩室接受呼吸支持的 NEC 婴儿比例较高（11（69）与 2（13），P=0.001）。入院后第二天（中位数[IQR]）的舒张压（39mmHg[34-42]，与 43mmHg[37-51]，P=0.112）和入院后 48 小时内（中位数[IQR]）的最低 pH 值（7.24[7.17-7.35]与 7.38[7.27-7.43]，P=0.157）在 NEC 婴儿中均无显著降低，但两者均显示出 NEC 婴儿中（相对）缺氧/缺血的相似趋势。
我们的临床结果支持（近）足月 CHD 婴儿中 NEC 的缺氧/缺血发病机制，表现为 Apgar 评分较低、分娩室中需要更多的呼吸支持，以及发生 NEC 的 CHD 婴儿的舒张压和 pH 值有下降趋势。
