Tan Recep Berra Zumrut, Öztürk Erkut
Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey.
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey.
Pediatr Neonatol. 2025 Sep;66(5):496-499. doi: 10.1016/j.pedneo.2024.09.006. Epub 2025 Feb 18.
This study aimed to investigate the frequency of necrotizing enterocolitis (NEC) and its influencing factors in term newborns diagnosed with critical congenital heart disease.
The study was conducted retrospectively on term neonates diagnosed with critical congenital heart disease who were admitted to the pediatric cardiac intensive care unit between January 1, 2022, and January 1, 2024. The frequency of NEC and the risk factors contributing to its development were evaluated in the cases. The results were analyzed statistically.
There were 400 cases during the study period, with 52% being male. The median weight was 2900 g (IQR 2800-3000 g). NEC development was observed in 12 cases (3%). Ten cases were ductus-dependent (10/320), and two cases were diagnosed with other critical congenital heart diseases (2/80). The median age at diagnosis was 7 days (IQR 5-10 days). According to the modified Bell criteria, six patients had NEC stage IIA, four had stage IIB, one had stage IIIA, and one had stage IIIB. Surgical treatment was administered to three cases (25%). Independent risk factors for NEC included gestational age <38 weeks (OR 5.9, p = 0.004), birth weight <2500 g (OR 3.2, p = 0.02), mechanical ventilation dependency (OR 6.4, p = 0.01), >6 packed red blood cells (OR 6.4, p = 0.01), parenteral nutrition (OR 9, p < 0.001), and presence of functional single ventricle (OR 6.8, p = 0.008). The mortality rate was higher in cases with NEC compared to those without (50% vs. 7.7%, p < 0.001).
NEC is a common complication in term neonates diagnosed with critical congenital heart disease. Low birth weight and gestational age, single ventricle physiology, mechanical ventilation dependency, excessive blood product usage, and parenteral nutrition increase the risk of NEC development in these cases.
本研究旨在调查诊断为重症先天性心脏病的足月儿坏死性小肠结肠炎（NEC）的发生率及其影响因素。
对2022年1月1日至2024年1月1日期间入住儿科心脏重症监护病房的诊断为重症先天性心脏病的足月儿进行回顾性研究。评估病例中NEC的发生率及其发生发展的危险因素，并对结果进行统计学分析。
研究期间共有400例病例，其中男性占52%。中位体重为2900 g（四分位间距2800 - 3000 g）。观察到12例（3%）发生NEC。10例为动脉导管依赖型（10/320），2例诊断为其他重症先天性心脏病（2/80）。诊断时的中位年龄为7天（四分位间距5 - 10天）。根据改良贝尔标准，6例患者为NEC IIA期，4例为IIB期，1例为IIIA期，1例为IIIB期。3例（25%）接受了手术治疗。NEC的独立危险因素包括胎龄<38周（比值比5.9，p = 0.004）、出生体重<2500 g（比值比3.2，p = 0.02）、依赖机械通气（比值比6.4，p = 0.01）、输注>6单位浓缩红细胞（比值比6.4，p = 0.01）、肠外营养（比值比9，p < 0.001）以及存在功能性单心室（比值比6.8，p = 0.008）。与未发生NEC的病例相比，发生NEC的病例死亡率更高（50% 对7.7%，p < 0.001）。
NEC是诊断为重症先天性心脏病的足月儿的常见并发症。低出生体重和胎龄、单心室生理状态、依赖机械通气、大量使用血液制品以及肠外营养会增加这些病例发生NEC的风险。
