Outcomes Analysis of Necrotizing Enterocolitis Within 11 958 Neonates Undergoing Cardiac Surgical Procedures

Mukherjee, Debraj; Zhang, Yi Yi; Chang, David C.; Brenner, Joel I.

doi:10.1001/archsurg.2010.39

Cited by 36 publications

(22 citation statements)

References 21 publications

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“…In this study, all NEC events were observed in the SV group, consistent with the findings of previous studies [17, 18]. However, splanchnic rSO 2 showed no corresponding difference between the SV patients with and without NEC before or after initiation of feedings.…”

Section: Discussionsupporting

confidence: 92%

“…Necrotizing enterocolitis (NEC), a neonatal disease in which the mucosal barrier of the gut is inflamed and breached by pathogenic enteric bacteria, resulting in intestinal injury, is one such morbidity associated with CCHD and CHS [17, 18]. In particular, single-ventricle (SV) heart disease and systemic-to-pulmonary artery shunting are associated with the development of NEC [17, 18].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, single-ventricle (SV) heart disease and systemic-to-pulmonary artery shunting are associated with the development of NEC [17, 18]. …”

Section: Introductionmentioning

confidence: 99%

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Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

et al. 2014

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Infants with critical congenital heart disease, especially patients with a single-ventricle (SV) physiology, are at increased risk for the development of necrotizing enterocolitis (NEC). Decreased splanchnic oxygen delivery may contribute to the development of NEC and may be detected by regional oximetry (rSO2) via splanchnic near-infrared spectroscopy (NIRS). This prospective study enrolled 64 neonates undergoing biventricular (BV) repair or SV palliation for CHD and monitored postoperative splanchnic rSO2 before and during initiation of enteral feedings to determine whether changes in rSO2 are associated with risk of NEC. Suspected or proven NEC was observed in 32 % (11/34) of the SV subjects and 0 % (0/30) of the BV subjects (p = 0.001). Compared with the BV subjects, the SV palliated subjects had significantly lower splanchnic rSO2 before and during initiation of enteral feedings, but the groups showed no difference after correction for lower pulse oximetry (SpO2) in the SV group. The clinical parameters were similar among the SV subjects with and without NEC except for cardiopulmonary bypass times, which were longer for the patients who experienced NEC (126 vs 85 min; p = 0.03). No difference was observed in splanchnic rSO2 or in the SpO2–rSO2 difference between the SV subjects with and without NEC. Compared with the patients who had suspected or no NEC, the subjects with proven NEC had a lower average splanchnic rSO2 (32.6 vs 47.0 %; p = 0.05), more time with rSO2 less than 30 % (48.8 vs 6.7 %; p = 0.04) at one-fourth-volume feeds, and more time with SpO2–rSO2 exceeding 50 % (33.3 vs 0 %; p = 0.03) before feeds were initiated. These data suggest that splanchnic NIRS may be a useful tool for assessing risk of NEC, especially in patients with an SV physiology.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

et al. 2014

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“…In a previously conducted retrospective study using the National Inpatient Sample and the Kids’ Inpatient Database, infants with congenital heart disease were evaluated for the development of NEC after undergoing cardiac surgery. 12 The investigators identified infants who developed NEC and who had a coexisting diagnosis of congenital heart disease. Of the 194 patients with congenital heart disease who developed NEC, 57 were diagnosed with secundum ASD, and 61 were diagnosed with a VSD in isolation.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that, of all infants who underwent surgery with heart disease and developed NEC, approximately 60% had either an ASD or a VSD. 12 A study of infants with left-to-right intra-cardiac shunt, inclusive of infants with ASD, VSD, atrioventricular septal defect, and persistent ductus arteriosus, demonstrated increased frequency of NEC. 13 In our analysis, we excluded infants with a diagnosis of atrioventricular septal defect and those treated with prostaglandins.…”

Section: Discussionmentioning

confidence: 99%

Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects

et al. 2014

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Objective Necrotizing enterocolitis (NEC) is associated with significant morbidity and mortality in premature infants. We sought to identify the frequency of NEC in very-low-birth-weight infants with isolated ventricular septal defects (VSD) or atrial septal defects (ASD) using a large multicenter database. Methods We identified a cohort of infants with birth weight <1500 g cared for in 312 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2010. We examined the association between presence of an ASD or a VSD with development of NEC using logistic regression to control for small-for-gestational-age status, antenatal steroid use, antenatal antibiotic use, gestational age, sex, race, Apgar score at 5 minutes, and method of delivery. Results Of the 98,523 infants who met inclusion criteria, 1,904 (1.9%) had an ASD, 1943 (2.0%) had a VSD, and 146 (0.1%) had both. The incidence of NEC was 6.2% in infants without septal defects, 9.3% in those with an ASD, 7.8% in those with a VSD, and 10.3% in infants with both an ASD and a VSD. Compared to infants without septal defects, the adjusted odds ratios for developing NEC for each group—ASD alone, VSD alone, and ASD with VSD—were 1.26 (95% confidence interval 1.06–1.49), 1.27 (1.08–1.52), and 1.80 (1.03–3.12), respectively. Conclusion The presence of an ASD or a VSD was associated with NEC in this cohort of premature infants.

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Nutrition Management: Parenteral and Enteral Nutrition and Oral Intake

Vichayavilas

Kashtan

2018

Congenital Heart Disease

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Outcomes Analysis of Necrotizing Enterocolitis Within 11 958 Neonates Undergoing Cardiac Surgical Procedures

Cited by 36 publications

References 21 publications

Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery

Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects

Nutrition Management: Parenteral and Enteral Nutrition and Oral Intake

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