Necrotizing enterocolitis and congenital heart disease: differences in management and prognosis.

R Mena Marcos, G Guillén Burrieza, A Castrillo Arias, S López Fernández, M Martos Rodríguez, A Montaner Ramón, A Creus, M G López Paredes, J A Molino Gahete
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Abstract

Objectives: Necrotizing enterocolitis (NEC) is a main cause of neonatal morbimortality. Gut prematurity and ischemia-reperfusion injury contribute to NEC and characterize two different scenarios: prematurity and congenital cardiopathy (CC). Our aim is to investigate whether CC worsens NEC gastrointestinal and general prognosis.

Materials and methods: NEC episodes from 2015-2023 were reviewed and classified into CC and non-CC. Patients with focal intestinal perforation were excluded. Data regarding NEC debut and management, surgical timing, intestinal segment involved and short-term outcomes were compared.

Results: Out of 205 neonates, 15 were excluded for unavailable records or uncertain diagnosis. 190 cases were included, 59 with CC. Comparing CC and non-CC, no significant differences were found in weight or age at diagnosis, or NEC stage. Hemodynamic (HD) shock [38.98% vs 24.43% (p <  0.05)] and need for vasoactive support at debut were more frequent in CC patients [44.07% vs 23.66% (p < 0.05)]. No differences were found regarding need for surgery at debut, length of resected intestine or segment affected or days on parenteral nutrition. CC conditioned longer hospital stay [110.8 ± 68.4 days vs 68.4 ± 44.6 (p <  0.05)] and higher mortality [30.5 vs 11.5 (p <  0.05)].

Conclusions: NEC in CC patients presents more HD instability at debut and worse global prognosis, probably due to inherent cardiovascular compromise, but need for surgery, type of intestinal involvement and short-term outcomes are similar to non-CC NEC.

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坏死性小肠结肠炎和先天性心脏病:管理和预后的差异。
目的:坏死性小肠结肠炎(NEC坏死性小肠结肠炎(NEC)是新生儿死亡的主要原因。肠道早产和缺血再灌注损伤是导致 NEC 的原因,也是两种不同情况的特征:早产和先天性心脏病(CC)。我们的目的是研究CC是否会恶化NEC的胃肠道和总体预后:回顾2015-2023年的NEC病例,并将其分为CC和非CC。排除局灶性肠穿孔患者。比较了有关 NEC 首次发病和处理、手术时机、涉及的肠段和短期预后的数据:结果:在 205 例新生儿中,有 15 例因无法获得记录或诊断不明确而被排除。共纳入 190 例,其中 59 例为 CC。CC 和非 CC 新生儿在体重、诊断时的年龄或 NEC 分期方面没有明显差异。血流动力学(HD)休克[38.98% vs 24.43% (p < 0.05)]和首次就诊时需要血管活性支持在CC患者中更为常见[44.07% vs 23.66% (p 结论:CC患者的血流动力学休克和首次就诊时需要血管活性支持在CC患者中更为常见:CC患者的NEC在首发时表现出更多的高密度脂蛋白血症不稳定性和更差的总体预后,这可能是由于固有的心血管损害,但手术需求、肠道受累类型和短期预后与非CC NEC相似。
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Evaluation of quality of life and satisfaction in patients undergoing laparoscopic Mitrofanoff procedure. How far do we want to go? Innovation and challenges: minimally invasive surgery training in Latin America. Necrotizing enterocolitis and congenital heart disease: differences in management and prognosis. Optimizing pediatric laparoscopic cholecystectomy: trocar reduction with percutaneous gallblader traction.
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