足月患依赖导管型先天性心脏病婴儿发生坏死性小肠结肠炎。
Development of necrotizing enterocolitis in full-term infants with duct dependent congenital heart disease.
机构信息
Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
出版信息
BMC Pediatr. 2022 Apr 2;22(1):174. doi: 10.1186/s12887-022-03186-5.
BACKGROUND
Although many studies have described an increased risk of necrotizing enterocolitis in duct dependent congenital heart diseases, very few have investigated its occurrence in full-term infants with duct dependent congenital heart diseases.
METHODS
To evaluate the characteristics and risk factors of necrotizing enterocolitis, we performed a retrospective review of 355 full-term infants with duct dependent congenital heart diseases who received prostaglandin E therapy from April 2000 to May 2020.
RESULTS
Necrotizing enterocolitis was observed in 10 patients (3.0%). Their average gestational age and birth weight were 38.2 weeks and 2783.5 g, respectively. The median age at diagnosis was 8.0 days (2-70 days). One patient was diagnosed with necrotizing enterocolitis stage IIA, five with stage IIB, two with stage IIIA, and two with stage IIIB; two (20%) received surgical treatment. The duct dependent pulmonary circulation group had higher frequencies of necrotizing enterocolitis (4.4%) than the duct dependent systemic circulation (2.0%) and parallel circulation (1.3%) groups. The necrotizing enterocolitis and the other groups had significantly different birth weight (2783.5 g vs 3170.9 g, respectively) and gestational age (38.2 weeks vs 39.1 weeks, respectively). Gestational age under 38 weeks (OR 8.87, p = 0.002), birth weight of < 2500 g (OR 5.1, p = 0.042), need for mechanical ventilation (OR 4.6, p = 0.021), parenteral nutrition (OR 107.7, p < 0.001), and functional single ventricle (OR 5.8, p = 0.009) were significant risk factors. The case-fatality rate was higher in the necrotizing enterocolitis (40.0%) than in the other group (8.3%, p = 0.009).
CONCLUSIONS
Three percent of full-term infants with duct dependent congenital heart diseases developed necrotizing enterocolitis. Neonates with low birth weight, gestational age less than 38 weeks, functional single ventricle, or receiving assisted mechanical ventilation or parenteral nutrition are at increased risk.
背景
尽管许多研究描述了依赖导管的先天性心脏病患者发生坏死性小肠结肠炎的风险增加，但很少有研究调查完全依赖导管的先天性心脏病患者中坏死性小肠结肠炎的发生情况。
方法
为了评估坏死性小肠结肠炎的特征和危险因素，我们对 2000 年 4 月至 2020 年 5 月接受前列腺素 E 治疗的 355 例足月依赖导管的先天性心脏病患者进行了回顾性分析。
结果
10 例（3.0%）患儿发生坏死性小肠结肠炎。他们的平均胎龄和出生体重分别为 38.2 周和 2783.5g。中位诊断年龄为 8.0 天（2-70 天）。1 例患儿诊断为坏死性小肠结肠炎ⅡA 期，5 例患儿诊断为ⅡB 期，2 例患儿诊断为ⅢA 期，2 例患儿诊断为ⅢB 期；2 例（20%）患儿接受了手术治疗。依赖导管的肺循环组坏死性小肠结肠炎的发生率（4.4%）高于依赖导管的体循环组（2.0%）和并行循环组（1.3%）。坏死性小肠结肠炎组与其他组患儿的出生体重（分别为 2783.5g 和 3170.9g）和胎龄（分别为 38.2 周和 39.1 周）存在显著差异。胎龄小于 38 周（OR 8.87，p=0.002）、出生体重小于 2500g（OR 5.1，p=0.042）、需要机械通气（OR 4.6，p=0.021）、肠外营养（OR 107.7，p<0.001）和功能性单心室（OR 5.8，p=0.009）是显著的危险因素。坏死性小肠结肠炎患儿的病死率（40.0%）高于其他组（8.3%，p=0.009）。
结论
3%的完全依赖导管的先天性心脏病患儿发生了坏死性小肠结肠炎。出生体重低、胎龄小于 38 周、功能性单心室或接受辅助机械通气或肠外营养的新生儿发生坏死性小肠结肠炎的风险增加。
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