Intestinal location of necrotizing enterocolitis among infants with congenital heart disease

Cozzi, C; Aldrink, Jennifer H.; Nicol, Kathleen; Nicholson, Lisa; Clifford, L.

doi:10.1038/jp.2013.49

Cited by 19 publications

(18 citation statements)

References 18 publications

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“…This is exactly what is seen clinically in patients with congenital heart disease, with the small intestine being at most risk for necrotising enterocolitis in these patients. 14,15 There are several limitations to this study. The sample size was small, and no association could be drawn with mesenteric flow characteristics and incidence of necrotising enterocolitis owing to this issue.…”

Section: Discussionmentioning

confidence: 97%

Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

et al. 2014

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Section: Discussionmentioning

confidence: 97%

Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

et al. 2014

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“…Regional NIRS monitoring of the liver, which is less mobile than the bowel, has been shown to correlate with systemic venous saturation [19]. This may be an alternative site for splanchnic rSO 2 monitoring in the future, although the liver is supplied by the celiac artery, and the majority of CHD patients experience NEC in locations primarily supplied by the superior mesenteric artery [4]. …”

Section: Discussionmentioning

confidence: 99%

Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

et al. 2014

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Infants with critical congenital heart disease, especially patients with a single-ventricle (SV) physiology, are at increased risk for the development of necrotizing enterocolitis (NEC). Decreased splanchnic oxygen delivery may contribute to the development of NEC and may be detected by regional oximetry (rSO2) via splanchnic near-infrared spectroscopy (NIRS). This prospective study enrolled 64 neonates undergoing biventricular (BV) repair or SV palliation for CHD and monitored postoperative splanchnic rSO2 before and during initiation of enteral feedings to determine whether changes in rSO2 are associated with risk of NEC. Suspected or proven NEC was observed in 32 % (11/34) of the SV subjects and 0 % (0/30) of the BV subjects (p = 0.001). Compared with the BV subjects, the SV palliated subjects had significantly lower splanchnic rSO2 before and during initiation of enteral feedings, but the groups showed no difference after correction for lower pulse oximetry (SpO2) in the SV group. The clinical parameters were similar among the SV subjects with and without NEC except for cardiopulmonary bypass times, which were longer for the patients who experienced NEC (126 vs 85 min; p = 0.03). No difference was observed in splanchnic rSO2 or in the SpO2–rSO2 difference between the SV subjects with and without NEC. Compared with the patients who had suspected or no NEC, the subjects with proven NEC had a lower average splanchnic rSO2 (32.6 vs 47.0 %; p = 0.05), more time with rSO2 less than 30 % (48.8 vs 6.7 %; p = 0.04) at one-fourth-volume feeds, and more time with SpO2–rSO2 exceeding 50 % (33.3 vs 0 %; p = 0.03) before feeds were initiated. These data suggest that splanchnic NIRS may be a useful tool for assessing risk of NEC, especially in patients with an SV physiology.

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“…The poor outcome for NEC patients with concomitant CHD has already been described in a number of studies, but these also included patients with Bell stage I and lacked a comparison with the data provided by NEC patients without CHD ( 6 , 7 ). Furthermore, these studies only included pre-term infants ( 8 ) or patients who were treated surgically ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis

et al. 2018

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Background: Studies on the influence of congenital heart disease (CHD) on neonates with necrotizing enterocolitis (NEC) have produced varied results. We therefore examined the influence of CHD on NEC outcomes.Methods: We carried out a retrospective single-center study including infants with confirmed NEC, treated between 2004 and 2017. We excluded patients with isolated patent ductus arteriosus or pulmonary hypertension (n = 45) and compared outcomes of patients with hemodynamically relevant CHD (n = 38) and those without CHD (n = 91).Results: Patients with CHD were more mature than those without CHD [gestational age, median, 95% confidence interval (CI95), 37.1, 34.5–37.2w, vs. 32.6, 31.9–33.3w; P < 0.01]. The presence of CHD did not influence the frequencies of severe disease (overall 21% Bell stage III), nor surgical interventions (overall 30%), the occurrence of intestinal complications (overall 13%), nor the duration of hospitalization (overall 38 days in survivors). The overall mortality as well as NEC-related mortality was increased with the presence of CHD, being 50% (19 out of 38) and 13% (5 out of 38), respectively, when compared to patients without CHD, being 8% (7 out of 91) and 3% (3 out of 91). The presence of CHD and of advanced NEC stage III were independent predictors of NEC-associated fatalities with multivariable odds ratios (CI95) of 7.0, 1.3–39.5 for CHD, and of 3.4, 1.6–7.5 for stage III disease.Conclusions: While some outcome parameters in neonates with NEC remained unaffected by the presence of CHD, the mortality risk for patients with CHD was seven times higher than without CHD.

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Intestinal location of necrotizing enterocolitis among infants with congenital heart disease

Abstract: Despite differences in gestational age between non-CHD and CHD patients, the location of NEC in these infants did not differ.

Cited by 19 publications

References 18 publications

Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis

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