Development of necrotizing enterocolitis in full-term infants with duct dependent congenital heart disease

Gwang-Jun Choi; Jinyoung Song; Hanna Kim; June Huh; I-Seok Kang; Yun Sil Chang; Se In Sung; Myung Chul Hyun

doi:10.1186/s12887-022-03186-5

Development of necrotizing enterocolitis in full-term infants with duct dependent congenital heart disease

BMC Pediatr. 2022 Apr 2;22(1):174. doi: 10.1186/s12887-022-03186-5.

Authors

Gwang-Jun Choi¹, Jinyoung Song², Hanna Kim³, June Huh³, I-Seok Kang³, Yun Sil Chang³, Se In Sung³, Myung Chul Hyun¹

Affiliations

¹ Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea.
² Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. amyjys@naver.com.
³ Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Abstract

Background: Although many studies have described an increased risk of necrotizing enterocolitis in duct dependent congenital heart diseases, very few have investigated its occurrence in full-term infants with duct dependent congenital heart diseases.

Methods: To evaluate the characteristics and risk factors of necrotizing enterocolitis, we performed a retrospective review of 355 full-term infants with duct dependent congenital heart diseases who received prostaglandin E₁ therapy from April 2000 to May 2020.

Results: Necrotizing enterocolitis was observed in 10 patients (3.0%). Their average gestational age and birth weight were 38.2 weeks and 2783.5 g, respectively. The median age at diagnosis was 8.0 days (2-70 days). One patient was diagnosed with necrotizing enterocolitis stage IIA, five with stage IIB, two with stage IIIA, and two with stage IIIB; two (20%) received surgical treatment. The duct dependent pulmonary circulation group had higher frequencies of necrotizing enterocolitis (4.4%) than the duct dependent systemic circulation (2.0%) and parallel circulation (1.3%) groups. The necrotizing enterocolitis and the other groups had significantly different birth weight (2783.5 g vs 3170.9 g, respectively) and gestational age (38.2 weeks vs 39.1 weeks, respectively). Gestational age under 38 weeks (OR 8.87, p = 0.002), birth weight of < 2500 g (OR 5.1, p = 0.042), need for mechanical ventilation (OR 4.6, p = 0.021), parenteral nutrition (OR 107.7, p < 0.001), and functional single ventricle (OR 5.8, p = 0.009) were significant risk factors. The case-fatality rate was higher in the necrotizing enterocolitis (40.0%) than in the other group (8.3%, p = 0.009).

Conclusions: Three percent of full-term infants with duct dependent congenital heart diseases developed necrotizing enterocolitis. Neonates with low birth weight, gestational age less than 38 weeks, functional single ventricle, or receiving assisted mechanical ventilation or parenteral nutrition are at increased risk.

Keywords: Congenital heart disease; Necrotizing enterocolitis; Patent ductus arteriosus.

MeSH terms

Birth Weight
Enterocolitis, Necrotizing* / epidemiology
Enterocolitis, Necrotizing* / etiology
Enterocolitis, Necrotizing* / surgery
Heart Defects, Congenital* / complications
Heart Defects, Congenital* / epidemiology
Humans
Infant
Infant, Low Birth Weight
Infant, Newborn
Infant, Newborn, Diseases*