Balati Kaiyishaer, Xu Zhuoming, Zhu Limin, Gong Xiaolei
Department of Neonatology, Second People's Hospital of Kashi Prefecture, Kashi, 844099, Xinjiang Province, China.
Cardiac intensive care unit, Department of Cardiothoracic Surgery, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
Ital J Pediatr. 2025 Mar 24;51(1):93. doi: 10.1186/s13052-025-01928-6.
This study aimed to analyze the clinical characteristics and differences between neonates with congenital heart disease (CHD)-related neonatal necrotizing enterocolitis (NEC) and those with non-CHD-related neonatal NEC.
This retrospective study included patients with CHD who met Bell's staging diagnostic criteria and were hospitalized between 2014 and 2023 in the Cardiac Intensive Care Unit of Cardiothoracic Surgery, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. These patients comprised the CHD-related NEC group (CHD-NEC group). Meanwhile, the control group included randomly matched non-CHD-related NEC children (nCHD-NEC group) admitted to the neonatal department of the Second People's Hospital in Kashi Prefecture according to the 1:2 matching principle. Patients' basic information, adverse clinical events before NEC onset as well as NEC severity and treatment were recorded.
The CHD-NEC group comprised 60 cases, whereas the nCHD-NEC group comprised 120 cases. Compared with the nCHD-NEC group, the CHD-NEC group had an older gestational age (38.71 [37.89, 39.67] weeks vs. 30.65 [29.68, 32.29] weeks, p < 0.001); a heavier birth weight (3.2 [2.69, 3.67] kg vs. 1.39 [1.1, 1.59] kg, p < 0.001); and higher proportions of patent ductus arteriosus (73.3% vs. 26.7%, p < 0.001), shock (81.7% vs. 36.7%, p < 0.001), and mechanical ventilation requirement (91.7% vs. 51.7%, p < 0.001). At disease onset, the CHD-NEC group had a higher vasoactive drug score (16.75 [7.26, 23.63] vs. 0 [0, 10], p < 0.001) but lower values for the proportion of infants who were small for gestational age (15% vs. 33.3%, p = 0.045), incidence of premature rupture of membranes (3.3% vs. 26.7%, p = 0.002), incidence of early onset sepsis (6.7% vs. 23.3%, p = 0.038), and incidence of late onset sepsis (46.7% vs. 70%, p = 0.036) than the nCHD-NEC group. Among children who required abdominal surgery, the CHD-NEC group tended to have more colon involvement (6.6% vs. 0.8%, p = 0.063), but no significant difference in mortality was noted between the two groups.
Children with CHD-NEC and nCHD-NEC have significantly different clinical characteristics. CHD-NEC is mainly observed in full-term infants with appropriate weight for gestational age, and perioperative intestinal ischemia may be the main pathophysiology. Conversely, nCHD-NEC is mainly noted in preterm infants, possibly related to immature intestinal development and infection. Large prospective clinical research is warranted to explore the pathogenesis, pathophysiology, indicator monitoring, and treatment plan for children with NEC.
本研究旨在分析患有先天性心脏病（CHD）相关新生儿坏死性小肠结肠炎（NEC）的新生儿与非CHD相关新生儿NEC的临床特征及差异。
本回顾性研究纳入了符合贝尔分期诊断标准且于2014年至2023年期间在上海交通大学医学院附属上海儿童医学中心心胸外科心脏重症监护病房住院的CHD患者。这些患者组成CHD相关NEC组（CHD-NEC组）。同时，对照组包括根据1:2匹配原则随机匹配的喀什地区第二人民医院新生儿科收治的非CHD相关NEC患儿（非CHD-NEC组）。记录患者的基本信息、NEC发病前的不良临床事件以及NEC的严重程度和治疗情况。
CHD-NEC组有60例，而非CHD-NEC组有120例。与非CHD-NEC组相比，CHD-NEC组的胎龄更大（38.71[37.89, 39.67]周 vs. 30.65[29.68, 32.29]周，p<0.001）；出生体重更重（3.2[2.69, 3.67]kg vs. 1.39[1.1, 1.59]kg，p<0.001）；动脉导管未闭比例更高（73.3% vs. 26.7%，p<0.001）、休克比例更高（81.7% vs. 36.7%，p<0.001）以及机械通气需求比例更高（91.7% vs. 51.7%，p<0.001）。在疾病发作时，CHD-NEC组的血管活性药物评分更高（16.75[7.26, 23.63] vs. 0[0, 10]，p<0.001），但小于胎龄儿比例更低（15% vs. 33.3%，p = 0.045）、胎膜早破发生率更低（3.3% vs. 26.7%，p = 0.002）、早发型败血症发生率更低（6.7% vs. 23.3%，p = 0.038）以及晚发型败血症发生率更低（46.7% vs. 70%，p = 0.036）。在需要进行腹部手术的儿童中，CHD-NEC组结肠受累倾向更明显（6.6% vs. 0.8%，p = 0.063），但两组之间的死亡率无显著差异。
CHD-NEC患儿和非CHD-NEC患儿具有显著不同的临床特征。CHD-NEC主要见于胎龄和体重适宜的足月儿，围手术期肠道缺血可能是主要病理生理学机制。相反，非CHD-NEC主要见于早产儿，可能与肠道发育不成熟和感染有关。有必要开展大型前瞻性临床研究以探索NEC患儿的发病机制、病理生理学、指标监测及治疗方案。
