World Journal of Pediatrics

, Volume 12, Issue 1, pp 55–59 | Cite as

Outcome in neonates with necrotizing enterocolitis and patent ductus arteriosus

  • Ulf Kessler
  • Franzisca Schulte
  • Dietmar Cholewa
  • Mathias Nelle
  • Stephan C. Schaefer
  • Peter M. Klimek
  • Steffen Berger
Original article



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.


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.


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 nonsurvival 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).


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.

Key words

congenital heart disease necrotizing enterocolitis neonatal mortality patent ductus arteriosus 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Polin RA, Pollack PF, Barlow B, Wigger HJ, Slovis TL, Santulli TV, et al. Necrotizing enterocolitis in term infants. J Pediatr 1976;89:460–462.PubMedCrossRefGoogle Scholar
  2. 2.
    Ostlie DJ, Spilde TL, St Peter SD, Sexton N, Miller KA, Sharp RJ, et al. Necrotizing enterocolitis in full-term infants. J Pediatr Surg 2003;38:1039–1042.PubMedCrossRefGoogle Scholar
  3. 3.
    Pickard SS, Feinstein JA, Popat RA, Huang L, Dutta S. Shortand long-term outcomes of necrotizing enterocolitis in infants with congenital heart disease. Pediatrics 2009;123:e901-e906.Google Scholar
  4. 4.
    Havranek T, Rahimi M, Hall H, Armbrecht E. Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes. J Matern Fetal Neonatal Med 2014;29:1–5.Google Scholar
  5. 5.
    Dees E, Lin H, Cotton RB, Graham TP, Dodd DA. Outcome of preterm infants with congenital heart disease. J Pediatr 2000;137:653–659.PubMedCrossRefGoogle Scholar
  6. 6.
    McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatriccs 2000;106:1080–1087.CrossRefGoogle Scholar
  7. 7.
    Mukherjee D, Zhang Y, Chang DC, Vricella LA, Brenner JI, Abdullah F. Outcomes analysis of necrotizing enterocolitis within 11 958 neonates undergoing cardiac surgical procedures. Arch Surg 2010;145:389–392.PubMedCrossRefGoogle Scholar
  8. 8.
    Guner YS, Friedlich P, Wee CP, Dorey F, Camerini V, Upperman JS. State-based analysis of necrotizing enterocolitis outcomes. J Surg Res 2009;157:21–29.PubMedCrossRefGoogle Scholar
  9. 9.
    Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1–7.PubMedGoogle Scholar
  10. 10.
    Ballance WA, Dahms BB, Shenker N, Kliegman RM. Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr 1990;117:S6–S13.PubMedCrossRefGoogle Scholar
  11. 11.
    Gonzalez-Rivera R, Culverhouse RC, Hamvas A, Tarr PI, Warner BB. The age of necrotizing enterocolitis onset: an application of Sartwell’s incubation period model. J Perinatol 2011;31:519–523.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Carlo WF, Kimball TR, Michelfelder EC, Border WL. Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease. Pediatrics 2007;119:330–335.PubMedCrossRefGoogle Scholar
  13. 13.
    Luig M, Lui K; NSW & ACT NICUS Group. Epidemiology of necrotizing enterocolitis—Part I: Changing regional trends in extremely preterm infants over 14 years. J Paediatr Child Health. 2005;41:169–173.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ulf Kessler
    • 1
    • 4
  • Franzisca Schulte
    • 1
  • Dietmar Cholewa
    • 1
  • Mathias Nelle
    • 2
  • Stephan C. Schaefer
    • 3
  • Peter M. Klimek
    • 1
  • Steffen Berger
    • 1
  1. 1.Department of Pediatric Surgery, InselspitalUniversity Hospital and University of BernBernSwitzerland
  2. 2.Division of Neonatology, Department of Pediatrics, InselspitalBern University Hospital and University of BernBernSwitzerland
  3. 3.Institute of Pathology, InselspitalUniversity of BernBernSwitzerland
  4. 4.Department of SurgeryHFR Fribourg-Cantonal HospitalBernSwitzerland

Personalised recommendations