Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from Classical Necrotizing Enterocolitis

Siano, E.; Lauriti, Giuseppe; Ceccanti, Silvia; Zani, Augusto

doi:10.1055/s-0038-1668144

Cited by 42 publications

(46 citation statements)

References 82 publications

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“…Previous studies have demonstrated the association of NEC with CHD, presenting controversial results on incidence, associations, and mortality (3,8,10,(13)(14)(15)(16) with various population sizes and subgroup analyses. Siano et al (8) reported that congenital heart defects could be identified as a risk factor for the incidence of NEC (OR 1.849) and increased mortality rates (OR 3.4). Lau et al (16) associated patients with ductal dependent congenital heart disease with an elevated risk of NEC compared to their counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…Inflammatory processes by baseline elevation of circulating endotoxin and proinflammatory cytokines (e.g., sepsis, systemic inflammation, shock) are the possible cause of further injuries, such as bowel necrosis. In recent research, separation of pathophysiology, incidence, and mortality of NEC in CHD patients and NEC in preterm infants was brought into focus (8)(9)(10). Accordingly, impaired intestinal perfusion and reduced intestinal arterial oxygen saturation in infants with cyanotic heart disease outrank classical causes in pathogenesis and are the leading causes for its development and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics of Necrotizing Enterocolitis in Preterm Patients With and Without Persistent Ductus Arteriosus and in Patients With Congenital Heart Disease

et al. 2020

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Background: Diagnosis and management of NEC is based on clinical, radiological, and laboratory findings. Discrimination of pathogens for an improved understanding of NEC in preterm infants and NEC in infants with congenital heart disease has been previously discussed and enables evaluation of further NEC biomarkers. Patients and Methods: Within a study period of 11 years (2008-2019), we identified 107 patients with a diagnosis of NEC at our primary care center. Thirty-six out of 54 patients suffering from NEC in high Bell stages who underwent surgery met inclusion criteria. These patients were classified according to their cardiac status, and analyses of clinical factors influencing NEC were conducted. Additionally, clinical factors associated with a fulminant course of NEC were examined. Univariable and multivariable analyses were performed. Results: The study populations consisted of 12 preterm infants with NEC but without patent ductus arteriosus (PT-NEC), seven preterm infants with NEC and patent ductus arteriosus (PDA-NEC), and 17 infants with NEC and congenital heart disease (CHD-NEC). Blood flow in intestinal vessels was impaired in infants with PDA-NEC and CDH-NEC. Therefore, we used logistic regression to compare PDA-NEC and CDH-NEC infants with PT-NEC infants: positive bacterial culture of intraoperative swabs (p = 0.0199; odds ratio: 21.9) and macroscopic intestinal necrosis (p = 0.0033; odds ratio: 43.5) were observed more frequently in the first group. Furthermore, multiple regression analysis determined the NEC localization (p = 0.0243) as a significant factor correlated with a fulminant course. Compared to a NEC exclusively localized in the colon, there is a 5.8-fold increased risk of a fulminant course when the small intestine is affected and a 42-fold increase of risk when both small intestine and colon were affected. Conclusion: An early diagnosis and timely surgical intervention of NEC, especially in infants with PDA and CDH may be considered to avoid major bowel necrosis (resulting in loss of intestinal tissue) and multiple operations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Necrotizing Enterocolitis in Preterm Patients With and Without Persistent Ductus Arteriosus and in Patients With Congenital Heart Disease

et al. 2020

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“…Major risk factors include preterm birth, low birthweight, congenital cardiac anomalies, and formula-feeding. [5][6][7] Initiatives to reduce the incidence of NEC have focused on modifiable risk factors with the NEC-zero committee strongly recommending the use of human breast milk and avoidance of antacids. 8 Maximizing the effectiveness of such interventions to reduce the morbidity of NEC, however, requires clinicians to accurately identify those at greatest risk of developing more severe forms of the disease.…”

Section: Introductionmentioning

confidence: 99%

Effect of Feeding Strategies on the Development of Fulminant Necrotizing Enterocolitis

et al. 2020

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Introduction Necrotizing enterocolitis (NEC) causes significant neonatal morbidity. A subset of infants experience precipitous decline and death from fulminant-NEC (F-NEC). We sought to determine the effect of feeding practices on the development of this more virulent form of NEC. Materials and Methods Premature neonates developing Bell's stage II or III NEC between May 2011 and June 2017 were reviewed. Infants were stratified as having NEC or F-NEC, defined as NEC-totalis or NEC causing rapid decline and death within 72 hours. Risk factors extracted included demographics, gestational age, and weight at NEC diagnosis. Feeding data extracted included age at first feed, caloric density, type of feed (breast milk or formula), and whether full volume feeds were reached. Univariate analysis and multivariate analysis were performed. Results A total of 98 patients were identified, of which 80 were included. In total, 57 patients had NEC and 23 had F-NEC. Reaching full volume feeds was associated with F-NEC on both univariate and multivariate analysis (37.9 vs. 4.5%; odds ratio: 67, 95% confidence interval: 6.606–2041, p = 0.003). Infants developing F-NEC achieved full feeds earlier (22.5 vs. 19.8 days, p = 0.025) on univariate but not multivariate analysis. There was no difference in the rates of NEC and F-NEC among infants receiving breast milk (standard or fortified) or formula (standard or increased caloric density; p = 0.235). Conclusion Among premature neonates with NEC, reaching full volume feedings was associated with a nearly 70-fold increased risk of F-NEC. Assuming it was possible to predict an infant's development of NEC, alternative feeding regimens might reduce the risk of F-NEC in this population.

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“…Our results indicate that oral administration of a dual-strain probiotic might be beneficial to reduce the rate of NEC in infants with aortic arch malformations. The low frequencies of overall and postoperative NEC in our center are rather in the lower range of the various NEC frequencies reported in previous studies, making analyses whether the administration of probiotics has an influence on the frequency of NEC in CHD patients challenging [2, 5, 6].…”

Section: Discussionmentioning

confidence: 92%

“…Presence of a congenital heart disease (CHD), particularly a complex or ductal-dependent CHD, is a major risk factor for the development of NEC in near-term and full-term neonates [2-4]. The incidence of NEC in term infants with CHD has been reported to be 3–11%, which is substantially higher than rates reported for the entire population of late preterm and term newborns [2, 5, 6].…”

Section: Introductionmentioning

confidence: 99%

Effect of a Dual-Strain Probiotic on Necrotizing Enterocolitis in Neonates with Ductal-Dependent Congenital Heart Disease: A Retrospective Cohort Study

et al. 2020

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Background: Newborns with ductal-dependent congenital heart disease (CHD) are at increased risk for developing necrotizing enterocolitis (NEC). Objectives: To investigate whether the use of dual-strain probiotics is beneficial for prevention of NEC in CHD patients, as demonstrated for premature infants. Study Design: Single-center retrospective cohort study of newborns with ductal-dependent CHD before and after implementation of oral dual-strain probiotics containing Bifidobacterium infantis and Lactobacillus acidophilus, on each day of exposure to prostaglandin E1 (PGE1). Results: Birth weight, gestational age, and distribution of heart defects were similar in both cohorts. NEC occurred in 6 of 247 (2.4%) patients without probiotics, and in 3 of 242 (1.2%) patients who received probiotics (p = 0.504). NEC-related mortality (0.4 vs. 0.4%, p = 1.000) and overall mortality (11.0 vs. 8.7%, p = 0.448) were likewise not different. PGE1 exposure was 1,788 and 2,455 days, respectively. In subgroup analysis of 152 infants with aortic arch malformations, such as coarctation of the aorta and interrupted aortic arch, we observed a significant reduction of NEC frequency (5.6 vs. 0.0%, p = 0.048). Conclusions: This is the first study to investigate the effect of a dual-strain probiotic on NEC in CHD patients. Infants with aortic arch malformations appear to benefit from dual-strain probiotics. Due to the scarcity of concurrence of ductal-dependent CHD and NEC, a clinical trial on probiotics to decrease risk of NEC in infants with ductal-dependent CHD would require several thousand infants.

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Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from Classical Necrotizing Enterocolitis

Cited by 42 publications

References 82 publications

Clinical Characteristics of Necrotizing Enterocolitis in Preterm Patients With and Without Persistent Ductus Arteriosus and in Patients With Congenital Heart Disease

Clinical Characteristics of Necrotizing Enterocolitis in Preterm Patients With and Without Persistent Ductus Arteriosus and in Patients With Congenital Heart Disease

Effect of Feeding Strategies on the Development of Fulminant Necrotizing Enterocolitis

Effect of a Dual-Strain Probiotic on Necrotizing Enterocolitis in Neonates with Ductal-Dependent Congenital Heart Disease: A Retrospective Cohort Study

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