Primary peritoneal drainage in neonates with necrotizing enterocolitis associated with congenital heart disease: a single experience in a Brazilian tertiary center

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.

坏死性小肠结肠炎（Necrotizing enterocolitis, NEC）是早产儿常见病症。其发病相关危险因素包括窒息、呼吸暂停、低血压、败血症以及先天性心脏病（congenital heart diseases, CHD）。本研究旨在评估合并先天性心脏病的坏死性小肠结肠炎（NEC+CHD）新生儿接受手术或腹腔引流治疗与不良预后之间的关联。本研究为一项开展于2000年至2019年的19年回顾性队列研究。纳入标准为Bell II期坏死性小肠结肠炎患儿，排除标准为合并先天畸形或遗传综合征、未行超声心动图检查，以及诊断为Bell I期坏死性小肠结肠炎的患儿。本研究共纳入100例新生儿，其中单纯NEC组52例、NEC+CHD组48例。上述两组进一步细分为：单纯NEC手术组（NECS，n=31）、单纯NEC腹腔引流组（NECD，n=19）、NEC+CHD手术组（NECCAS，n=21）以及NEC+CHD腹腔引流组（NECCAD，n=29）。以出生体重和胎龄为协变量，开展多因素分析以评估死亡相对风险与住院时长。各组基线特征均衡可比。校正后分析显示，腹腔引流组的死亡相对风险更高：NECD组校正相对风险（Adj RR）=2.70（95%置信区间：1.47；4.97），NECCAD组Adj RR=1.97（95%置信区间：1.08；3.61）；且两组至死亡的时间最短：NECD组为8.72（95%置信区间：3.10；24.54），NECCAD组为5.32（95%置信区间：1.95；14.44）。本研究得出结论：对合并或不合并先天性心脏病的坏死性小肠结肠炎新生儿实施一期腹腔引流，既未延长生存天数，也未降低死亡风险，且与伴临床不稳定的坏死性小肠结肠炎新生儿更高的死亡率相关。