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.