Necrotizing Enterocolitis in Infants with Ductal-Dependent Congenital Heart Disease

Abstract

Objective Infants with congenital heart disease (CHD) receiving prostaglandins (PGE) may be at increased risk for necrotizing enterocolitis (NEC). Enteral feeding may further increase risk of NEC in these patients. We evaluated the incidence of NEC and its association with enteral feeding in infants with ductal-dependent CHD. Study Design We examined a cohort of infants with CHD receiving PGE in neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2010. We used logistic regression to evaluate the association between NEC and enteral feeding, as well as other risk factors including antacid medications, inotropic and ventilator support, and anatomic characteristics, controlling for gestational age. Results We identified 6710 infants with ductal-dependent CHD receiving PGE for 17,158 infant days. NEC occurred in 21 of 6710 (0.3%) infants, of whom 12/21(57%) were <37 weeks gestational age. The incidence of NEC was 1.2/1000 infant days while on enteral feeds versus 0.4/1000 infant days while not on enteral feeds (p=0.27). Enteral feeding was not associated with a statistically significant increased odds of NEC on the day of diagnosis (odds ratio [OR] 2.08; 95% confidence interval [CI] 0.38, 11.7). Risk factors associated with a significant increased odds of NEC included a diagnosis of single-ventricle heart defect (OR 2.82; 95% CI 1.23, 6.49), although the overall risk in this population remained low (8/1631, 0.5%). Conclusion The incidence of NEC in our cohort of infants with ductal-dependent CHD on PGE therapy was low and did not increase with enteral feeding.

Evaluating the Impact of a Feeding Protocol in Neonates before and after Biventricular Cardiac Surgery

“… 14 This risk of NEC is higher among single ventricle physiology patients. 15 – 17 On the contrary, other studies have shown preoperative enteral feeding can be associated with decreased risk of prolonged feeding difficulties postoperatively in some populations and 18 delaying enteral feeding may contribute to increased gut abnormalities and even delayed postnatal intestinal development, maturation, and motility problems. 19 These data suggest the importance of enterally feeding hemodynamically stable patients preoperatively.…”

A multicenter prospective study of neonatal outcomes at less than 32 weeks associated with indications for maternal admission and delivery

“…One of the important features of this network is its Neonatal Data Warehouse, which includes deidentified data from the neonatal intensive care units in which its doctors practice and the data are derived directly from the electronic medical record of the neonates in each unit on a real-time basis. This data set has been used by the National Institutes of Health, 25,26 the Food and Drug Administration, 27 the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Pediatric Trials Network, 28,29 and others to define and evaluate national trends in neonatal intensive care unit diagnoses and therapies. Ten hospitals were included in this study, including only those which had both Obstetrix MFM practices and Pediatrix neonatology practices.…”

The features of nutritional status in children with congenital heart disease

“…Многочисленные исследования показали увеличение частоты развития некротизирующего энтероколита у пациентов с врожденными пороками сердца [11][12][13][14][15][16][17]. Частота некротизирующего энтероколита у детей раннего возраста с врожденными пороками сердца колеблется, по разным данным, от 3,3 до 6,8 %, что намного превышает риск развития этого заболевания у новорожденных с неизмененным анатомическим строением сердца [14].…”

“…Becker и соавт. [11] показано, что энтеральное кормление не ассоциируется со статистически значимым увеличением частоты развития некротизирующего энтероколита.…”