Diastolic blood pressure in term infants with congenital heart disease and necrotizing enterocolitis.

Heide, M. van der (Martin) (2015) Diastolic blood pressure in term infants with congenital heart disease and necrotizing enterocolitis. thesis, Medicine.

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Abstract

Introduction Necrotizing enterocolitis (NEC) is a devastating disease of the newborn infant that relatively frequent affects term infants with congenital heart disease (CHD). Currently, the underlying mechanism of the increased risk of NEC in term infants with CHD remains poorly understood. Furthermore, early diagnostic factors for term infants with CHD who develop NEC are lacking. One of the hypotheses for the pathogenesis of term infants with CHD and NEC states that low body perfusion due to the retrograde diastolic flow in the ductus arteriosus, represented by a low diastolic blood pressure, results in ischemia of the intestine. A low body perfusion, measured as low diastolic blood pressure might therefore be predictive for the development of NEC in term infants with CHD. Aim of study The aim of this study is to investigate whether the mean diastolic blood pressure, before NEC onset, is lower in term infants with CHD who develop NEC than term infants with only CHD. Methods From December 2003 to December 2013, 18 infants out of 470 infants with CHD and a gestational age ≥35 weeks, admitted to our NICU, developed NEC and were retrospectively included in this case-control study. These infants were matched 1:1 with patients who did not develop NEC from the same cohort. We matched by type of CHD and date of birth. The diastolic blood pressure values were collected at first day after admission, two days and one day prior to NEC onset. Severity of disease was assessed by Bell’s stage. We used a Mann Whitney U test to assess differences in diastolic blood pressure between infants with CHD who develop NEC and infants with CHD who do not develop NEC. Main results We found no significant differences in mean diastolic blood pressure between NEC cases and matched controls at the day of admission and two or one day(s) prior to NEC onset. However, when NEC cases were categorized by Bell’s stage, diastolic blood pressure tended to be lower at day one of admission in infants with Bell’s stage 3 (median 34.4 mmHg, interquartile range (IQR) 34.2-36.5) compared to Bell’s stage 1 (median 49.7 mmHg, IQR 41.6-57.8, p=0.08) and compared to Bell’s stage 2 (median 43.9 mmHg, IQR 39.7-47.1, p=0.07). Furthermore, mean diastolic blood pressure in Bell’s stage 3 patients (median 34.4 mmHg, IQR 34.2-36.5) compared to their matched controls (median 41.8 mmHg, IQR 40.3-45.9) tended to be lower at day one after admission (p=0.05). Conclusion While low diastolic blood pressure might not be associated with the occurrence of NEC in CHD patients, it might be associated with a complicated course of NEC. Diastolic blood pressure however may not be the most accurate measure to predict tissue perfusion.

Item Type:	Thesis (Thesis)
Supervisor name:	Kooi, Elisabeth M. W.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:49
Last Modified:	25 Jun 2020 10:49
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/994

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