Abnormal Abdominal Aorta Hemodynamics Are Associated With Necrotizing Enterocolitis in Infants With Hypoplastic Left Heart Syndrome

Abstract

Background The risk of necrotizing enterocolitis (NEC) in association with congenital heart disease is highest in patients with hypoplastic left heart syndrome (HLHS). Within the HLHS population, however, risk factors for NEC remain debated. We hypothesized that some infants with HLHS have vascular changes that contribute to gut hypoperfusion, independent of diastolic run-off and low cardiac output. Methods We analyzed the abdominal aorta pulsatility index and right ventricular function on routine pre-operative and post-operative echocardiograms for all infants who underwent stage I palliation for HLHS from January 2007 to January 2012. The echocardiography findings and clinical course were compared between those with and those without an episode of NEC. Results Of the 61 cases reviewed, 11 (18%) developed NEC during a mean follow-up of 3.8 ±1.3 years. Those with NEC had a lower abdominal aorta pulsatility index compared to those without NEC both on stage I pre-operative (3.38 ±0.15 vs. 3.89 ±0.09, p<0.05) and post-operative echocardiograms (2.21 ±0.28 vs. 3.05 ±0.78, p=0.01) despite similar ventricular function and operative risk. Conclusions Abdominal aorta Doppler pulsations are lower in patients with HLHS whose clinical course is complicated by NEC. This finding suggests that the systemic vasculature in a subset of neonates with HLHS may be inherently abnormal. Further investigation is warranted to determine if this is secondary to structural changes in the mesenteric and/or systemic vasculature.

Necrotizing Enterocolitis in Multi Fetal Pregnancies: Can We Find a Key in Placental Abnormalities? A Retrospective Data Analysis

“…This hypoperfusion could result in subtle hypoxic damage that increases the risk of developing NEC after birth. The potential association between bowel hypoperfusion and NEC has been described in neonates with hypoplastic left heart syndrome, coarctatio aortae and related abnormal abdominal aorta hemodynamics [12]. In this study, unbalanced interfetal transfusion was found significantly more often in MC multiples developing NEC, supporting our hypothesis.…”

Randomized Clinical Trial of Preoperative Feeding to Evaluate Intestinal Barrier Function in Neonates Requiring Cardiac Surgery

“…(3, 5, 10–12) Despite the high incidence of gastrointestinal morbidity and growth failure in the cardiac infant population, there is a paucity of knowledge regarding the specific intestinal mucosal and barrier insults incurred during neonatal cardiac surgery.…”

Perioperative Feeding Approaches in Single Ventricle Infants: A Survey of 46 Centers

“…Preoperative concerns reported in this survey included the risk of NEC, prostaglandin E1 (PGE1) use and presence of umbilical arterial catheter (UAC). NEC in congenital heart disease (CHD) is a universal concern which is associated with higher morbidity and mortality . McElhinney performed a case control study for development of NEC in 643 infants with CHD and showed that the diagnosis of HLHS was independently associated with development of NEC.…”