Congenital Heart Disease Increases Mortality in Neonates With Necrotizing Enterocolitis

Abstract

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.

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

“…Most recently, discrimination of NEC in preterm infants and NEC in infants with concomitant cardiac malformations has been the subject of intensive research. 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).…”

“…Secondarily, Bubberman et al (9) suggest further differentiation of pathophysiology of NEC between the subgroups based on a primary inflammatory process to assess disease severity. Accordingly, Bubberman et al (10) stated an association of PT-NEC patients and elevated CRP values. However, this association remains to be controversially discussed.…”

“…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.…”

Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis

“…Necrotizing enterocolitis (NEC) is one of the main causes for morbidity and mortality in preterm neonates [1]. NEC survivors frequently suffer from neurodevelopmental impairment and gastrointestinal sequelae [2,3]. To date, Communicated by Daniele De Luca however, the pathophysiology of NEC, as well as the factors associated with disease severity, has not been sufficiently investigated.…”

Immediate Post-operative Enterocyte Injury, as Determined by Increased Circulating Intestinal Fatty Acid Binding Protein, Is Associated With Subsequent Development of Necrotizing Enterocolitis After Infant Cardiothoracic Surgery

“…NEC, in particular, is a dangerous complication. Comorbid CHD and NEC have been shown to have high overall mortality (50-57%) (14,15) and significantly increased length of hospitalization compared to CHD alone (36 vs. 19 days) (16). At this time, no clinically available biomarker exists to help identify specific intestinal damage following infant cardiac surgery.…”