Increased incidence of necrotizing enterocolitis in very/extremely preterm infants with early hypotension: a retrospective cohort study.

Background: The relationship between neonatal early hypotension and necrotizing enterocolitis (NEC) remains uncertain, with inconsistent findings reported in previous studies. The objective of this study was to assess whether early hypotension in very/extremely preterm infants was associated with an increased risk of NEC, aiming to facilitate early detection and prevention. Methods: A retrospective cohort analysis was performed in preterm infants with gestational ages (GA) less than 32 weeks, admitted to the Seventh Medical Center of the Chinese PLA General Hospital from January 2021 through December 2023. According to the occurrence of hypotension during the first postpartum week, preterm infants were divided into hypotension group and non-hypotension groups. Statistical analysis was conducted using SPSS software (version 26.0). The association between neonatal early hypotension and subsequent NEC occurrence was analyzed using univariate and multivariate logistic regression. Results: A total of 355 very/extremely preterm infants were included, comprising 130 in the hypotension group and 225 in the non-hypotension group. Compared with the non-hypotension group, infants in the hypotension group had significantly higher rates of mortality, hemodynamically significant patent ductus arteriosus (hsPDA), NEC, and surgically treated NEC (all P>0.05). After adjusting for potential confounders, neonatal early hypotension remained significantly associated with an increased incidence of NEC [odds ratio (OR) =2.80, 95% confidence interval (CI): 1.25-6.28, P=0.01]. Conclusions: Neonatal early hypotension is associated with an increased risk of NEC.