Necrotizing enterocolitis in neonates with congenital heart disease: Risk factors and outcomes
Necrotizing enterocolitis in neonates with congenital heart disease: Risk factors and outcomes
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DOI：
10.1542/peds.106.5.1080
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发表时间：
2000-11-01
期刊：
影响因子：
8
通讯作者：
Wernovsky, G
中科院分区：
文献类型：
--
作者：
McElhinney, DB;Hedrick, HL;Wernovsky, G
Objective.坏死性小肠结肠炎（NEC）主要是早产儿的疾病。然而，在足月出生的儿童中，先天性心脏病可能是这种情况的重要诱发因素。为了确定先天性心脏病患者NEC的危险因素，我们对1995年1月至1998年12月4年期间在我中心心脏重症监护室住院的心脏病新生儿进行了病例对照研究。在643例患者的初始队列中，分析了心脏病诊断和入院时的年龄与NEC的相关性。回顾性记录了21例发生NEC的先天性心脏病新生儿和70例入院时诊断和年龄相匹配的对照新生儿的人口统计学、术前和手术变量。使用参数和非参数分析，病例和对照组进行了比较，就以前确定的危险因素NEC。在643例心脏重症监护室的心脏病新生儿中，通过多变量分析，左心发育不良综合征（比值比[OR] = 3.8 [1.6-9.1]）和动脉干或肺动脉窗（OR = 6.3 [1.7-23.6]）的诊断与NEC的发生独立相关。在病例对照分析中，出生时胎龄较早（36.7 ± 2.7周vs 38.1 ± 2.3周），早产（OR = 3.9 [1.2-12.5]），前列腺素最高剂量>0.05 mug/kg/min（OR = 3.9 [1.2-12.5]），低心输出量（符合特定实验室标准）或临床休克（OR = 6.5 [1.8-23.5]）与NEC的发生相关。通过多变量分析，早期胎龄和低排血量是与NEC显著相关的唯一因素。虽然有和没有NEC的患者之间的住院死亡率没有差异，但NEC患者的平均住院时间明显更长（36 +/- 22天vs 19 +/- 14天）。新生儿先天性心脏病的NEC风险很大。与心脏病婴儿NEC风险升高相关的因素包括早产、左心发育不良综合征、动脉干和全身灌注不良或休克发作。对于有这些危险因素的新生儿，应高度怀疑。
Objective. Necrotizing enteroeolitis (NEC) is primarily a disease of the premature infant. Among children born at term, however, congenital heart disease may be an important predisposing factor for this condition. To determine risk factors for NEC in patients with congenital heart disease, we conducted a case-control study of neonates with cardiac disease admitted to the cardiac intensive care unit at our center during the 4-year period from January 1995 to December 1998.Methods. Cardiac diagnosis and age at admission were analyzed for association with NEC among the 643-patient inception cohort. Demographic, preoperative, and operative variables were recorded retrospectively in 21 neonates with congenital heart disease who developed NEC and 70 control neonates matched by diagnosis and age at admission. Using parametric and nonparametric analysis, cases and controls were compared with respect to previously identified risk factors for NEC.Results. Among the entire cohort of 643 neonates with heart disease admitted to the cardiac intensive care unit, diagnoses of hypoplastic left heart syndrome (odds ratio [OR] = 3.8 [1.6-9.1]) and truncus arteriosus or aortopulmonary window (OR = 6.3 [1.7-23.6]) were independently associated with development of NEC by multivariable analysis. In the case-control analysis, earlier gestational age at birth (36.7 +/- 2.7 weeks vs 38.1 +/- 2.3 weeks), prematurity (OR = 3.9 [1.2-12.5]), highest dose of prostaglandin >0.05 mug/kg/minute (OR = 3.9 [1.2-12.5]), and episodes of low cardiac output (meeting specific laboratory criteria) or clinical shock (OR = 6.5 [1.8-23.5]) correlated with the development of NEC. Earlier gestational age and episodes of low output were the only factors that remained significantly associated with NEC by multivariable analysis. Although there was no difference in hospital mortality between patients with and without NEC, mean hospital stay was significantly longer in those who developed NEC (36 +/- 22 days vs 19 +/- 14 days).Conclusions. The risk of NEC in neonates with congenital heart disease is substantial. Factors associated with an elevated risk of NEC in infants with heart disease include premature birth, hypoplastic left heart syndrome, truncus arteriosus, and episodes of poor systemic perfusion or shock. Heightened suspicion is warranted in newborns with these risk factors.