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Hypoxia tied to necrotizing enterocolitis in near term infants with CHD: Study
Researcher have recently found a hypoxic/ischemic pathophysiology of necrotizing enterocolitis 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 Necrotizing enterocolitis.
This study is published in the Journal of BMC Pediatrics.
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
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751