Association between hypertensive disorders of pregnancy and disease progression in preterm infants with necrotizing enterocolitis: a retrospective cohort study.

INTRODUCTION

The aim of this study was to investigate the association between hypertensive disorders of pregnancy (HDP) and disease progression in preterm infants with necrotizing enterocolitis (NEC), providing a basis for risk-stratified monitoring.

METHODS

We conducted a retrospective cohort study of 237 preterm neonates diagnosed with Bell stage II NEC at a tertiary level teaching hospital in China between January 2015 and January 2025. Statistical analyses included univariate analysis, multivariate logistic regression, smooth curve fitting, and threshold effect analysis.

RESULTS

Among the 237 mothers included, 54 (22.78%) presented HDP. Disease progression (to Bell stage III or death) occurred in 71 NEC patients (29.96% of the cohort). Infants in the HDP group presented a significantly lower progression rate compared to the non-HDP group (16.67% vs. 33.88%; OR, 0.36 [95% CI 0.14-0.92]). Furthermore, systolic blood pressure (SBP) was negatively correlated with NEC progression when the mean SBP was less than 171.20 mmHg, with each 1 mmHg increase associated with a 2% reduction in progression risk (95% CI, 0.96-0.99).

CONCLUSIONS

Maternal HDP and a SBP < 171.2 mmHg were associated with a decreased risk of NEC progression in preterm infants with Bell stage II NEC. These findings suggest that maternal blood pressure monitoring and hypertensive status may inform clinical decision-making in NEC management.