Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e901-e906 (doi:10.1542/peds.2008-3216)
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ARTICLE

Short- and Long-Term Outcomes of Necrotizing Enterocolitis in Infants With Congenital Heart Disease

Sarah S. Pickard, BSa, Jeffrey A. Feinstein, MD, MPHb, Rita A. Popat, PhD, MAc, Lyen Huang, MDa and Sanjeev Dutta, MD, MAa

Divisions of a Pediatric Surgery
b Pediatric Cardiology
c Epidemiology and Health Research Policy, Lucile Packard Children's Hospital and Stanford School of Medicine, Stanford University, Stanford, California

OBJECTIVE. Congenital heart disease is a significant risk factor for necrotizing enterocolitis in the term infant. We compared the short- and long-term necrotizing enterocolitis–specific outcomes of infants with congenital heart disease with those of neonates without congenital heart disease.

PATIENTS AND METHODS. A retrospective study of 202 patients with necrotizing enterocolitis treated at our center from May 1999 to August 2007 was conducted. Infants with necrotizing enterocolitis were grouped according to the presence (n = 76) or absence (n = 126) of congenital heart disease. Demographic and necrotizing enterocolitis–specific outcomes were recorded. The groups were compared by nonparametric and {chi}2 analyses. Univariate and multivariate odds ratios were determined for each outcome.

RESULTS. The average birth weight and gestational age of the 2 groups were not significantly different. The initial necrotizing enterocolitis severity, as determined by Bell stage, was less for necrotizing enterocolitis subjects with congenital heart disease compared with those without congenital heart disease. When controlling for birth weight and gestational age, the congenital heart disease group had decreased risk of perforation, need for a bowel operation, strictures, need for a stoma, sepsis, and short bowel syndrome compared with the non–congenital heart disease group. Although not statistically significant, subjects with congenital heart disease had a trend toward decreased risk of death from necrotizing enterocolitis, recurrent necrotizing enterocolitis, and need for peritoneal drainage.

CONCLUSIONS. Infants with congenital heart disease and necrotizing enterocolitis have decreased risk of major short- and long-term negative outcomes associated with necrotizing enterocolitis compared with neonates without congenital heart disease. Differences in initial severity, range of age at diagnosis, and prognoses between subjects with necrotizing enterocolitis with and without cardiac disease suggest that necrotizing enterocolitis in the cardiac patient is a distinct disease process and should be labeled cardiogenic necrotizing enterocolitis.

Key Words: necrotizing enterocolitis • congenital heart disease • patent ductus arteriosus

Abbreviations: NEC—necrotizing enterocolitis • CHD—congenital heart disease • PDA—patent ductus arteriosus • SBS—short bowel syndrome • OR—odds ratio • CNEC—cardiogenic necrotizing enterocolitis

Accepted Jan 9, 2009.


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