Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

Frid, Gabriela; Reppucci, Marina L.; Lum, Tony; Paul, Megan; Seiden, Howard; Coakley, Brian A.

doi:10.3389/fped.2021.802607

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…In the few days between birth and the development of NEC, these CHD infants were characterized by lower Apgar scores and increased respiratory support, with a trend toward lower pH and diastolic blood pressure, compared with age-matched CHD infants not developing NEC [ 35 ]. In addition, lower levels of platelets and C-reactive protein (CRP) in term NEC infants with CHD compared with preterm NEC infants without CHD provided further evidence of the ischemic nature of cardiac NEC in comparison with the more acute inflammatory classical NEC [ 18 ].…”

Section: Pathogenesis Of Intestinal Injury In Congenital Heart Diseasementioning

confidence: 99%

“…Infants with cardiac NEC are typically of higher birth weight and gestational age [ 15 ] than preterm infants with classical NEC. While some groups have argued that cardiac NEC more often involves the colon [ 16 , 17 , 18 ], the ileum, as with classical NEC, also appears to be a significant site of injury in cardiac NEC [ 19 , 20 , 21 ]. The postnatal age at which term CHD infants acquire NEC is often earlier than preterm infants with classical NEC [ 16 ], and preterm infants with DD cardiac NEC are often diagnosed at a later postnatal age than term infants with the same CHD diagnosis [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review

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Gunasekaran

Makoni

et al. 2022

JCM

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Neonates with congenital heart disease (CHD) are at an increased risk of developing necrotizing enterocolitis (NEC), an acute inflammatory intestinal injury most commonly associated with preterm infants. The rarity of this complex disease, termed cardiac NEC, has resulted in a dearth of information on its pathophysiology. However, a higher incidence in term infants, effects on more distal regions of the intestine, and potentially a differential immune response may distinguish cardiac NEC as a distinct condition from the more common preterm, classical NEC. In this review, risk factors, differentiated from those of classical NEC, are discussed according to their potential contribution to the disease process, and a general pathogenesis is postulated for cardiac NEC. Additionally, biomarkers specific to cardiac NEC, clinical outcomes, and strategies for achieving enteral feeds are discussed. Working towards an understanding of the mechanisms underlying cardiac NEC may aid in future diagnosis of the condition and provide potential therapeutic targets.

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Section: Pathogenesis Of Intestinal Injury In Congenital Heart Diseasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review

Burge

Gunasekaran

Makoni

et al. 2022

JCM

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“…[ 3 ] Full-term neonates, however, rarely develop NEC, with an incidence of 10%–12% among all newborns with NEC. [ 4 5 ]…”

Section: Introductionmentioning

confidence: 99%

SIGIRR gene variants in term newborns with congenital heart defects and necrotizing enterocolitis

Zaikova,

Kaplina,

Petrova

et al. 2023

Annals of Pediatric Cardiology

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Background: Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency among neonates which is characterized by acute intestinal inflammation and necrosis. The main risk factors for NEC are prematurity, low birth weight, and some preexisting health conditions such as congenital heart defects (CHDs). Investigation of the potential genetic predisposition to NEC is a promising approach that might provide new insights into its pathogenesis. One of the most important proteins that play a significant role in the pathogenesis of NEC is Toll-like receptor 4 (TLR4) which recognizes lipopolysaccharide found in Gram-negative bacteria. In intestinal epithelial cells, a protein encoded by the SIGIRR gene is a major inhibitor of TLR4 signaling. A few SIGIRR variants, including rare p.Y168X and p.S80Y, have already been identified in preterm infants with NEC, but their pathogenic significance remains unclear. This study aimed to investigate the spectrum of SIGIRR genetic variants in term newborns with CHD and to assess their potential association with NEC. Methods and Results: A total of 93 term newborns with critical CHD were enrolled in this study, 33 of them developed NEC. SIGIRR genetic variants were determined by Sanger sequencing of all exons. In total, eight SIGIRR genetic variants were identified, two of which were found only in newborns with NEC (P = 0.12). The rare missense p.S80Y (rs117739035) variant in exon 4 was found in two infants with NEC stage IIA. Two infants with NEC stage III and stage IB carried a novel duplication c. 102_121dup (rs552367848) variant in exon 10 that has not been previously associated with any clinical phenotype. Conclusions: The presence of both variants only in neonates who developed NEC, together with earlier published data, may suggest their potential contribution to the risk of developing NEC in term infants with CHD and allow planning larger cohort studies to clarify their relevance.

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Bedside Utilization of Intestinal Pathology in Preterm Infants with Surgical Necrotizing Enterocolitis

Garg,

Weis,

Shenberger

et al. 2024

Am J Perinatol

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Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with multi-organ dysfunction, multiple systemic morbidities and mortality. The resected bowel commonly shows evidence of coagulative necrosis, inflammation, interstitial hemorrhages, and reparative changes on the pathology examination. The severity of these pathological abnormalities may correlate with the disease's severity and pace of progression and may assist in the prediction of clinical outcomes. This review presents current evidence about the clinical utility of the intestinal pathology in bedside decision making, accurate diagnosing, prediction of outcomes, and in the prognostication of preterm infants with surgical NEC. Developing refined and validated noninvasive methods to diagnose the extent of bowel injury and monitoring of tissue repair throughout disease progression is paramount to mitigating the long-term morbidities in preterm infants with surgical NEC. Improved imaging methods such as targeted bowel ultrasound capable of assessing the inflammation and necrosis in real time will greatly advance care and provide focus for the temporal framework of surgical interventions.

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Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

Cited by 6 publications

References 26 publications

Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review

Clinical Characteristics and Potential Pathogenesis of Cardiac Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: A Narrative Review

SIGIRR gene variants in term newborns with congenital heart defects and necrotizing enterocolitis

Bedside Utilization of Intestinal Pathology in Preterm Infants with Surgical Necrotizing Enterocolitis

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