Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study

Abstract Background 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, bu...

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Main Authors: Martin van der Heide, Mirthe J. Mebius, Arend F. Bos, Marcus T.R. Roofthooft, Rolf M.F. Berger, Jan B.F. Hulscher, Elisabeth M.W. Kooi
Format: Article
Language:English
Published: BMC 2020-12-01
Series:BMC Pediatrics
Subjects:
Online Access:https://doi.org/10.1186/s12887-020-02446-6
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spelling doaj-26f79cf29edc452886a2437e7f6faf512020-12-07T23:00:10ZengBMCBMC Pediatrics1471-24312020-12-012011810.1186/s12887-020-02446-6Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control studyMartin van der Heide0Mirthe J. Mebius1Arend F. Bos2Marcus T.R. Roofthooft3Rolf M.F. Berger4Jan B.F. Hulscher5Elisabeth M.W. Kooi6Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalDivision of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalDivision of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalDivision of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalDivision of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalDepartment of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center GroningenDivision of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s HospitalAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12887-020-02446-6Necrotizing enterocolitiscongenital heart disease(near) term infantsdiastolic blood pressureApgar scorehypoxic/ischemic hits
collection DOAJ
language English
format Article
sources DOAJ
author Martin van der Heide
Mirthe J. Mebius
Arend F. Bos
Marcus T.R. Roofthooft
Rolf M.F. Berger
Jan B.F. Hulscher
Elisabeth M.W. Kooi
spellingShingle Martin van der Heide
Mirthe J. Mebius
Arend F. Bos
Marcus T.R. Roofthooft
Rolf M.F. Berger
Jan B.F. Hulscher
Elisabeth M.W. Kooi
Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
BMC Pediatrics
Necrotizing enterocolitis
congenital heart disease
(near) term infants
diastolic blood pressure
Apgar score
hypoxic/ischemic hits
author_facet Martin van der Heide
Mirthe J. Mebius
Arend F. Bos
Marcus T.R. Roofthooft
Rolf M.F. Berger
Jan B.F. Hulscher
Elisabeth M.W. Kooi
author_sort Martin van der Heide
title Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
title_short Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
title_full Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
title_fullStr Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
title_full_unstemmed Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
title_sort hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case control study
publisher BMC
series BMC Pediatrics
issn 1471-2431
publishDate 2020-12-01
description Abstract Background 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. Methods 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. Results 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. Conclusions 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.
topic Necrotizing enterocolitis
congenital heart disease
(near) term infants
diastolic blood pressure
Apgar score
hypoxic/ischemic hits
url https://doi.org/10.1186/s12887-020-02446-6
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