Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis
Background: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes.Methods: We carried out a retrospective single-center study including infants with confirme...
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Frontiers Media S.A.
2018-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2018.00312/full |
| _version_ | 1828869889735000064 |
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| author | Ulf Kessler Ulf Kessler Eva-Maria Hau Eva-Maria Hau Marcin Kordasz Stephanie Haefeli Catherine Tsai Peter Klimek Peter Klimek Dietmar Cholewa Mathias Nelle Mladen Pavlovic Steffen Berger |
| author_facet | Ulf Kessler Ulf Kessler Eva-Maria Hau Eva-Maria Hau Marcin Kordasz Stephanie Haefeli Catherine Tsai Peter Klimek Peter Klimek Dietmar Cholewa Mathias Nelle Mladen Pavlovic Steffen Berger |
| author_sort | Ulf Kessler |
| collection | DOAJ |
| description | Background: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes.Methods: We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension (n = 45) and compared outcomes of patients with hemodynamically relevant CHD (n = 38) and those without CHD (n = 91).Results: Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5–37.2w, vs. 32.6, 31.9–33.3w; P < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3–39.5 for CHD, and of 3.4, 1.6–7.5 for stage III disease.Conclusions: While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD. |
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| format | Article |
| id | doaj.art-9330d9b3199c443a864e5600d95e834d |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-13T06:00:14Z |
| publishDate | 2018-10-01 |
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| series | Frontiers in Pediatrics |
| spelling | doaj.art-9330d9b3199c443a864e5600d95e834d2022-12-21T23:57:22ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602018-10-01610.3389/fped.2018.00312414905Congenital Heart Disease Increases Mortality in Neonates With Necrotizing EnterocolitisUlf Kessler0Ulf Kessler1Eva-Maria Hau2Eva-Maria Hau3Marcin Kordasz4Stephanie Haefeli5Catherine Tsai6Peter Klimek7Peter Klimek8Dietmar Cholewa9Mathias Nelle10Mladen Pavlovic11Steffen Berger12Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandCenter of Visceral Surgery, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Cantonal Hospital Aarau, Aarau, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandBackground: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes.Methods: We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension (n = 45) and compared outcomes of patients with hemodynamically relevant CHD (n = 38) and those without CHD (n = 91).Results: Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5–37.2w, vs. 32.6, 31.9–33.3w; P < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3–39.5 for CHD, and of 3.4, 1.6–7.5 for stage III disease.Conclusions: While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD.https://www.frontiersin.org/article/10.3389/fped.2018.00312/fullnecrotizing enterocolitisNECcongenital heart diseaseCHDoutcomemortality |
| spellingShingle | Ulf Kessler Ulf Kessler Eva-Maria Hau Eva-Maria Hau Marcin Kordasz Stephanie Haefeli Catherine Tsai Peter Klimek Peter Klimek Dietmar Cholewa Mathias Nelle Mladen Pavlovic Steffen Berger Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis Frontiers in Pediatrics necrotizing enterocolitis NEC congenital heart disease CHD outcome mortality |
| title | Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis |
| title_full | Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis |
| title_fullStr | Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis |
| title_full_unstemmed | Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis |
| title_short | Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis |
| title_sort | congenital heart disease increases mortality in neonates with necrotizing enterocolitis |
| topic | necrotizing enterocolitis NEC congenital heart disease CHD outcome mortality |
| url | https://www.frontiersin.org/article/10.3389/fped.2018.00312/full |
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