title: Outcome in neonates with necrotizing enterocolitis and patent ductus arteriosus.
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.
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.|Department of Surgery, HFR Fribourg-Cantonal Hospital, Bern, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Kessler
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Franzisca
authors.initials: F
authors.lastname: Schulte
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Cholewa
authors.affiliation: Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Nelle
authors.affiliation: Institute of Pathology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Schaefer
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Klimek
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Berger
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000150:complications*; D020345:Enterocolitis, Necrotizing / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: congenital heart disease; necrotizing enterocolitis; neonatal mortality; patent ductus arteriosus