Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis

Lopez, Natasha L; Gowda, Charitha; Backes, Carl H.; Nandi, Deipanjan; Miller‐Tate, Holly; Fichtner, Samantha; Allen, Robin; Stewart, Jamie; Clifford, L.

doi:10.1111/chd.12602

Cited by 17 publications

(6 citation statements)

References 38 publications

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“…Cardiac NEC appears to be closely associated with several cardiac pathologies. Single ventricle defects, especially HLHS [ 7 , 10 , 13 , 68 ], account for the majority of CHDs associated with cardiac NEC. The mortality of single ventricle-associated cardiac NEC, approaching 25% with HLHS [ 13 ], is often a result of interplay with and among concomitant risk factors, such as prematurity and LBW.…”

Section: Risk Factors Contributing To Cardiac Nec Pathogenesismentioning

confidence: 99%

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: Risk Factors Contributing To Cardiac Nec Pathogenesismentioning

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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“…Necrotizing enterocolitis is more common in neonates with CHD compared to healthy neonates and can be associated with significant morbidity. In an analysis of data from the NPCQIC, the incidence of NEC was 5.8% in 1163 neonates with HLHS with a higher incidence below gestational age of 37 weeks, those requiring extracorporeal membrane oxygenation and those with moderate to severe atrioventricular valve regurgitation at the time of discharge [20]. Infants with NEC had a longer length of stay, lower WAZ and were more likely to be exclusively tube fed at the time of discharge and at the time of SCPC.…”

Section: Factors Contributing To Feeding Challenges and Etiology Of G...mentioning

confidence: 99%

Feeding challenges in the newborn with congenital heart disease

Ravishankar

2022

Current Opinion in Pediatrics

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Purpose of reviewFeeding challenges and growth failure are lifelong issues for infants with congenital heart disease. The purpose of this review is to summarize the literature on the topic from North America.Recent findingsDespite recognition of feeding challenges and ongoing national collaboration, >50% of infants with univentricular physiology continue to require supplemental tube feeds at the time of discharge from neonatal surgery. Preoperative feeding is now commonly used in prostaglandin dependent neonates with congenital heart disease. The value of a structured nutritional program with establishment of best practices in nutrition is well recognized in the current era. Despite implementation of these best practices, neonates undergoing cardiac surgery continue to struggle with weight gain prior to discharge. This suggests that there is more to growth than provision of adequate nutrition alone.SummaryThe National Pediatric Cardiology Quality Improvement Collaborative continues to play a major role in optimizing nutrition in infants with congenital heart disease. This among other registries underscores the importance of collaboration in improving overall outcomes for children with congenital heart disease. Nurses should be encouraged to lead both clinical and research efforts to overcome feeding challenges encountered by these children.

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“… 47 Lopez et al found that the incidence of extracorporeal membrane use was higher and HLHS patients who developed NEC were more likely to have moderate to severe atrioventricular valve regurgitation at times of discharge from the NPC-QIC database analysis. 45 In another study, Weiss et al 48 noted the rates of intra-abdominal complications to be more frequent in infants who underwent the hybrid procedure than those with the Sano or m-BTS procedure.…”

Section: Cardiac Surgery Perioperative Risk Factors and Necmentioning

confidence: 99%

“…Other than critical cardiac lesions, NEC can also result due to other associations of CHD like prostaglandin therapy, inotrope use, 14 cardiopulmonary bypass (CPB), extracorporeal membrane use, 45 red cell transfusions, especially if multiple. 19 The postoperative period is particularly vulnerable for gut necrosis resulting in significant morbidity and mortality.…”

Section: Cardiac Surgery Perioperative Risk Factors and Necmentioning

confidence: 99%

Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article

Maheshwari¹,

Roychaudhuri²,

Grewal³

et al. 2022

Newborn

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Necrotizing enterocolitis (NEC) is a relatively rare but devastating entity associated classically with the preterm cohort in the neonatal intensive care unit. Preterm and term babies with congenital heart disease are at risk of a number of comorbidities because of the hemodynamic derangements due to a structurally abnormal heart and the corrective procedures adopted. Necrotizing enterocolitis is one of the dreaded complications associated with this cohort and impacts the course of these babies in the hospital in a major way. A large majority of term babies with NEC are in the backdrop of a significant congenital cardiac lesion. This review article summarizes the literature and elaborates this entity including its specific features, risk factors associated with its causality, histopathology and related aspects of hemodynamics, and feeding in this vulnerable population. It also provides insight into modifiable risk factors and early markers of detection of gut necrosis to facilitate prevention and early detection. It highlights the subtle but definite difference in outcome variables to help physicians enable the parents of babies with heart disease to develop a better understanding of the entity and its expected course while counseling.

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Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis

Cited by 17 publications

References 38 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

Feeding challenges in the newborn with congenital heart disease

Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article

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