Ulf Kessler1,2, Franzisca Schulte1, Dietmar Cholewa1, Mathias Nelle3, Stephan C Schaefer4, Peter M Klimek1, Steffen Berger1. 1. Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland. 2. Department of Surgery, HFR Fribourg-Cantonal Hospital, Bern, Switzerland. 3. Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. 4. Institute of Pathology, Inselspital, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: There is no agreement of the influence of patent ductus arteriosus (PDA) on outcomes in patients with necrotizing enterocolitis (NEC). In this study, we assessed the influence of PDA on NEC outcomes. METHODS: A retrospective study of 131 infants with established NEC was performed. Outcomes (death, disease severity, need for surgery, hospitalization duration), as well as multiple clinical parameters were compared between NEC patients with no congenital heart disease (n=102) and those with isolated PDA (n=29). Univariate, multivariate and stepwise logistic regression analyses were performed. RESULTS: Birth weight and gestational age were significantly lower in patients with PDA [median (95% CI): 1120 g (1009-1562 g), 28.4 wk (27.8-30.5 wk)] than in those without PDA [median (95% CI): 1580 g (1593-1905 g), 32.4 wk (31.8-33.5 wk); P<0.05]. The risk of NEC-attributable fatality was higher in NEC patients with PDA (35%) than in NEC patients without PDA (14%)[univariate odds ratio (OR)=3.3, 95% CI: 1.8-8.6, P<0.05; multivariate OR=2.4, 95% CI: 0.82-2.39, P=0.111]. Significant independent predictors for non-survival within the entire cohort were advanced disease severity stage III (OR=27.9, 95% CI: 7.4-105, P<0.001) and birth weight below 1100 g (OR=5.7, 95% CI: 1.7-19.4, P<0.01). CONCLUSIONS: In patients with NEC, the presence of PDA is associated with an increased risk of death. However, when important differences between the two study groups are controlled, only birth weight and disease severity may independently predict mortality.
BACKGROUND: There is no agreement of the influence of patent ductus arteriosus (PDA) on outcomes in patients with necrotizing enterocolitis (NEC). In this study, we assessed the influence of PDA on NEC outcomes. METHODS: A retrospective study of 131 infants with established NEC was performed. Outcomes (death, disease severity, need for surgery, hospitalization duration), as well as multiple clinical parameters were compared between NEC patients with no congenital heart disease (n=102) and those with isolated PDA (n=29). Univariate, multivariate and stepwise logistic regression analyses were performed. RESULTS: Birth weight and gestational age were significantly lower in patients with PDA [median (95% CI): 1120 g (1009-1562 g), 28.4 wk (27.8-30.5 wk)] than in those without PDA [median (95% CI): 1580 g (1593-1905 g), 32.4 wk (31.8-33.5 wk); P<0.05]. The risk of NEC-attributable fatality was higher in NEC patients with PDA (35%) than in NEC patients without PDA (14%)[univariate odds ratio (OR)=3.3, 95% CI: 1.8-8.6, P<0.05; multivariate OR=2.4, 95% CI: 0.82-2.39, P=0.111]. Significant independent predictors for non-survival within the entire cohort were advanced disease severity stage III (OR=27.9, 95% CI: 7.4-105, P<0.001) and birth weight below 1100 g (OR=5.7, 95% CI: 1.7-19.4, P<0.01). CONCLUSIONS: In patients with NEC, the presence of PDA is associated with an increased risk of death. However, when important differences between the two study groups are controlled, only birth weight and disease severity may independently predict mortality.
Authors: D B McElhinney; H L Hedrick; D M Bush; G R Pereira; P W Stafford; J W Gaynor; T L Spray; G Wernovsky Journal: Pediatrics Date: 2000-11 Impact factor: 7.124
Authors: Daniel J Ostlie; Troy L Spilde; Shawn D St Peter; Nick Sexton; Kelly A Miller; Ronald J Sharp; George K Gittes; Charles L Snyder Journal: J Pediatr Surg Date: 2003-07 Impact factor: 2.545
Authors: Yigit S Guner; Philippe Friedlich; Choo Phei Wee; Fred Dorey; Victoria Camerini; Jeffrey S Upperman Journal: J Surg Res Date: 2008-12-04 Impact factor: 2.192
Authors: Mark Adams; Dirk Bassler; Brian A Darlow; Kei Lui; Brian Reichman; Stellan Hakansson; Mikael Norman; Shoo K Lee; Kjell K Helenius; Liisa Lehtonen; Laura San Feliciano; Maximo Vento; Marco Moroni; Marc Beltempo; Junmin Yang; Prakesh S Shah Journal: BMJ Open Date: 2019-10-14 Impact factor: 2.692
Authors: Sofia El Manouni El Hassani; Hendrik J Niemarkt; Joep P M Derikx; Daniel J C Berkhout; Andrea E Ballón; Margot de Graaf; Willem P de Boode; Veerle Cossey; Christian V Hulzebos; Anton H van Kaam; Boris W Kramer; Richard A van Lingen; Daniel C Vijlbrief; Mirjam M van Weissenbruch; Marc A Benninga; Nanne K H de Boer; Tim G J de Meij Journal: Eur J Pediatr Date: 2020-12-02 Impact factor: 3.183
Authors: W C Canesin; F A P Volpe; W A Gonçalves-Ferri; P H Manso; D C Aragon; L Sbragia Journal: Braz J Med Biol Res Date: 2021-05-31 Impact factor: 2.590