Hypoxia tied to necrotizing enterocolitis in near term infants with CHD: Study

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 Necrotizing enterocolitis 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.

Therefore, Martin van der Heide and colleagues from the Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands carried out the present study 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.

The authors included a total of 956 infants with CHD born after ≥ 35 weeks of gestational age who were retrospectively reviewed for this case-control study. infants with radiographically confirmed pneumatosis intestinalis and controls matched by type of congenital heart disease were enrolled in the study. Out of the total sample, 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.

The following findings were observed-

a. There were no significant demographic differences between both groups.

b. 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).

c. A higher proportion of infants with NEC required respiratory support in the delivery room (11(69) vs. 2(13), P = .001).

d. 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.

Hence, their results suggested, "a perinatal hypoxic/ischemic pathophysiology of Necrotizing enterocolitis in (near) term congenital heart disease infants with potential relative hypoxic/ischemic events."

For further reference log in to:

Van der Heide, M., Mebius, M.J., Bos, A.F. et al. Hypoxic/ischemic hits predispose to necrotizing enterocolitis in (near) term infants with congenital heart disease: a case-control study. BMC Pediatr 20, 553 (2020).

https://doi.org/10.1186/s12887-020-02446-6