Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article

Abstract

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.

Novel Biomarkers of Necrotizing Enterocolitis in Neonates Undergoing Congenital Heart Disease Surgery: A Pilot Cohort Study

“…Congenital heart disease (CHD) is a risk factor for the development of necrotizing enterocolitis (NEC). 1 NEC has an incidence of 3% to 5% in the population with CHD and is associated with a 2‐fold increase in mortality (24.4% versus 11.8% in neonates with CHD without NEC), and a 3‐fold increase in length of stay (54 versus 18 days). 1 , 2 Although poorly understood, cardiac NEC appears to be a distinct entity from NEC of prematurity.…”

“… 1 NEC has an incidence of 3% to 5% in the population with CHD and is associated with a 2‐fold increase in mortality (24.4% versus 11.8% in neonates with CHD without NEC), and a 3‐fold increase in length of stay (54 versus 18 days). 1 , 2 Although poorly understood, cardiac NEC appears to be a distinct entity from NEC of prematurity. 1 , 3 Biomarkers capable of predicting NEC in patients with CHD are lacking.…”

“… 1 , 2 Although poorly understood, cardiac NEC appears to be a distinct entity from NEC of prematurity. 1 , 3 Biomarkers capable of predicting NEC in patients with CHD are lacking. One candidate is intestinal fatty acid binding protein (iFABP/FABP2).…”

“…iFABP is highly expressed in the intestinal epithelium and is involved in lipid metabolism, control of inflammation, cell proliferation, and barrier function. 1 , 3 Circulating iFABP increases immediately after infant cardiac surgery and higher immediate postoperative levels are associated with increased risk of subsequent NEC. 4 iFABP's utility as a biomarker for the detection of acute NEC or the response to treatment has not been established.…”