Moschino Laura, Guiducci Silvia, Duci Miriam, Meggiolaro Leonardo, Nardo Daniel, Bonadies Luca, Salvadori Sabrina, Verlato Giovanna, Baraldi Eugenio
Department of Woman's and Child's Health, University of Padova, 35128 Padua, Italy.
Neonatal Intensive Care Unit, Padova University Hospital, 35128 Padua, Italy.
Children (Basel). 2024 Oct 31;11(11):1343. doi: 10.3390/children11111343.
Necrotizing enterocolitis (NEC) is the most frightening gastrointestinal emergency in newborns. Despite being primarily a disease of premature infants, neonates with congenital heart disease (CHD) are at increased risk of development. Acute and chronic hemodynamic changes in this population may lead to mesenteric circulatory insufficiency.
In this narrative review, we describe monitoring tools, alone or in multimodal use, that may help in the early recognition of patients with CHD at major risk of NEC development.
We focused on vital parameters, echocardiography, Doppler flowmetry, abdominal near-infrared spectroscopy (aNIRS), and abdominal ultrasound (aUS).
The number of studies on this topic is small and includes a wide range of patients' ages and types of CHD. Peripheral oxygen saturation (SpO) and certain echocardiographic indices (antegrade and retrograde velocity time integral, cardiac output, etc.) do not seem to differentiate infants with further onset of NEC from those not developing it. Hypotensive events, persistent diastolic flow reversal in the descending aorta, and low mesenteric oxygen saturation (rsSO) measured by aNIRS appear to occur more frequently in infants who later develop NEC. aUS may be helpful in the diagnosis of cardiac NEC, potentially showing air contrast tracked to the right atrium in the presence of pneumatosis.
This narrative review describes the current knowledge on bedside tools for the early prediction of cardiac NEC. Future research needs to further explore the use of easy-to-learn, reproducible instruments to assist patient status and monitor patient trends.
坏死性小肠结肠炎（NEC）是新生儿最可怕的胃肠道急症。尽管主要是早产儿的疾病，但患有先天性心脏病（CHD）的新生儿发生NEC的风险增加。该人群的急性和慢性血流动力学变化可能导致肠系膜循环不足。
在这篇叙述性综述中，我们描述了单独使用或多模式使用的监测工具，这些工具可能有助于早期识别有发生NEC重大风险的CHD患者。
我们重点关注生命体征参数、超声心动图、多普勒血流测定法、腹部近红外光谱法（aNIRS）和腹部超声（aUS）。
关于该主题的研究数量较少，涵盖了广泛的患者年龄和CHD类型。外周血氧饱和度（SpO）和某些超声心动图指标（正向和逆向速度时间积分、心输出量等）似乎无法区分会进一步发生NEC的婴儿和未发生NEC的婴儿。通过aNIRS测量的低血压事件、降主动脉持续舒张期血流逆转和低肠系膜血氧饱和度（rsSO）似乎在后来发生NEC的婴儿中更频繁出现。aUS可能有助于诊断心脏NEC，在存在气肿时可能显示空气造影剂追踪到右心房。
这篇叙述性综述描述了目前关于床边工具早期预测心脏NEC的知识。未来的研究需要进一步探索使用易于学习、可重复的仪器来评估患者状态并监测患者趋势。
