Necrotizing Enterocolitis in Neonates With Congenital Heart Disease: Risk Factors and Outcomes

McElhinney, Doff B.; Hedrick, Holly L.; Bush, David M.; Pereira, Gilberto R.; Stafford, Perry W.; Gaynor, J. William; Spray, Thomas L.; Wernovsky, Gil

doi:10.1542/peds.106.5.1080

Cited by 377 publications

(365 citation statements)

References 39 publications

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“…This association appears in the great majority of previously published cases of NEC among term infants. [2][3][4][5][6][7][8][9][10][11][12][14][15][16] On the basis of the present and previous reports, we maintain that NEC in term neonates is a problem essentially limited to those that have some underlying illness or condition requiring NICU admission. If this is correct, the problem of preventing NEC in term infants may be less daunting than we initially anticipated.…”

Section: Discussionmentioning

confidence: 67%

“…2 It is not clear whether NEC in term neonates is a fundamentally different disorder than NEC in preterm neonates, however, several authors have speculated that it is. 7,8,10,11,15 One often-sited unique feature is that term infants who develop NEC generally have an underlying congenital condition or disease (Table 5). This was certainly the case among our 30 patients, each of which had previously been admitted to a NICU for some reason other than NEC, and subsequently developed NEC as a complication of care.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, since 1973, published reports have described over 150 term and near-term neonates with NEC. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The prevalence of NEC among term neonates in the USA is not known, but Bolisetty et al 10 estimated that, in Australia, NEC occurs in one per 20 000 term births. As NEC is so rare among term neonates, it is challenging to develop and test prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

“…We suspected that more cases of NEC in term infants would exist in the recent Intermountain Healthcare databases than in any of the published reports of this condition. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Our speculation was based on the fact that all but one of the previous reports of NEC in term neonates 10 were the experiences of individual hospitals. Thus, we undertook the present study, for two purposes; (1) to describe the cases of NEC of Bell's stage XII in term neonates cared for in the Intermountain Healthcare NICU system in recent years and (2) to contrast data from these patients with data from term neonates admitted to the same NICUs that did not develop NEC.…”

Section: Introductionmentioning

confidence: 99%

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Necrotizing enterocolitis in term neonates: data from a multihospital health-care system

et al. 2007

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Objective: In the past 5½ years, 30 term or near-term neonates in the Intermountain Healthcare system developed necrotizing enterocolitis (NEC) Bell's stage XII. We sought to identify possible explanations for why these patients developed NEC, by comparing them with 5847 others that did not develop NEC, from the same hospitals and of the same gestational ages, cared for during the same 5½-year period.Study design: Data were collected from neonates admitted to any of the Intermountain Healthcare NICUs with a birth date from 1 January 2001 to 30 June 2006, and a gestational age >36 weeks. A variety of patient features and feeding practices were compared between those that did vs did not develop NEC.Result: Forty-one neonates >36 weeks gestation were listed in the discharge records as having NEC of Bell's stage II or higher. However, on review of these 41 medical records, 11 were seen to have had NEC of Bell's stage I, whereas the remaining 30 had radiographs and clinical courses indicative of Bell's stage XII. Those 30 formed the basis of this study. Twenty-eight of the 30 developed NEC after having been admitted to an NICU for some other reason; the other two developed NEC at home, within 2 days of being discharged from an NICU. The 30 that developed NEC were more likely than the 5847 that did not develop NEC, to have congenital heart disease (P ¼ 0.000), polycythemia (P ¼ 0.002), earlyonset bacterial sepsis (P ¼ 0.004) or hypotension (P ¼ 0.017). All 30 received enteral feedings before NEC developed; 29 were fed either artificial formula or a mixture of formula and breast milk. The one that was exclusively fed human milk was fed human milk with added fortifier (24 cal/oz). The 30 that developed NEC were more likely to be fed formula exclusively (P ¼ 0.000). Seven of the 30 had a laparotomy for NEC; two of the seven had total bowel necrosis and support was withdrawn. The other five had perforations and bowel resections. The mortality rate was 13% (4/30). Conclusion:In our series, NEC among term or near-term neonates was exclusively a complication developing among patients already admitted to a NICU for some other reason. We speculate that the combination of reduced mesenteric perfusion and feeding with artificial formula were factors predisposing them to develop NEC.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Necrotizing enterocolitis in term neonates: data from a multihospital health-care system

et al. 2007

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“…Additionally, other groups began reporting an increased risk of NEC in patients with complex congenital heart disease. [50][51][52] In many of these cases, the common pathological finding associated with NEC was a propensity of disease located at the ileocecal valve and the ascending colon, suggestive of an ischemic pathophysiology.…”

Section: Nec In the Fullterm Neonate (Term Nec)mentioning

confidence: 99%

Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?

et al. 2007

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In the last decade, it has become increasingly clear that necrotizing enterocolitis (NEC) is neither a uniform nor a well-defined disease entity. There are many factors that are forcing this unwelcome realization upon the neonatal and pediatric surgery communities. In the course of this manuscript we will review the history and the physical findings of the disparate etiologies of acquired neonatal intestinal diseases (ANIDs), some which do lead to the common final pathology of NEC and some which do not. New guidelines for distinguishing between ANIDs will also be suggested. (2007) Keywords: necrotizing enterocolitis; spontaneous intestinal perforation; neonate; intestine; premature; diagnosis A brief history of clinical NEC research in the presurfactant era During the late 1970s, necrotizing enterocolitis (NEC) was most commonly seen in preterm infants >30 weeks of gestation. Journal of Perinatology

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Outcomes Analysis of Necrotizing Enterocolitis Within 11 958 Neonates Undergoing Cardiac Surgical Procedures

et al. 2010

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Through an analysis of 2 databases, we describe outcomes among 11 958 neonates with congenital heart disease undergoing cardiac procedures, with 194 developing necrotizing enterocolitis (NEC). Neonates with congestive heart failure or those undergoing systemic to pulmonary artery shunting were more likely to develop NEC, but these patients had inpatient mortality similar to that of their non-NEC counterparts.

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Necrotizing Enterocolitis in Neonates With Congenital Heart Disease: Risk Factors and Outcomes

Cited by 377 publications

References 39 publications

Necrotizing enterocolitis in term neonates: data from a multihospital health-care system

Necrotizing enterocolitis in term neonates: data from a multihospital health-care system

Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?

Outcomes Analysis of Necrotizing Enterocolitis Within 11 958 Neonates Undergoing Cardiac Surgical Procedures

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