Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity?
Overview
Pediatrics
Authors
Affiliations
Background: Necrotizing enterocolitis (NEC) predominantly occurs in preterm infants (PT-NEC). In term neonates, NEC occurs more frequently when a congenital heart disease is present (CHDNEC). Our aim was to evaluate differences and similarities in disease characteristics of PT-NEC versus CHD-NEC.
Methods: In this retrospective case-control study we identified all CHD infants who developed NEC Bell's stage ≥2 in our center from 2004 to 2014. We randomly selected (1:2 ratio) PT-NEC infants from the same period. Biochemical and clinical variables were retrieved from patient files.
Results: We found 18 CHD-NEC infants and selected 36 PT-NEC infants (gestational age 28.3 [25-35.6] weeks vs. 38.6 [31.7-40.7] weeks). Postnatal age at onset was significantly lower in CHD-NEC patients (4 [2-24] vs. 11 [4-41] days, p < 0.001). Lowest pH levels were lower (7.21 [7.01-7.47] vs. 7.27 [6.68-7.39], p = 0.02), and highest CRP levels were higher (112.5 mg/L [5.0-425.0] vs. 66.0 [5.2-189.0], p = 0.05) in PT-NEC vs. CHD-NEC. Anatomic localisation of the disease differed: the colon was significantly more often involved in CHD-NEC versus PT-NEC (86% vs. 33%, p = 0.03). Mortality caused by NEC was not different (22% vs. 11%, p = 0.47).
Conclusion: While outcome of NEC in both groups is similar, the predominant NEC localisation differed between CHD-NEC and PT-NEC patients. This suggests that both variants of the disease have a different underlying pathophysiological mechanism that predisposes different intestinal regions to develop NEC.
Type Of Study: Retrospective Case-Control Study.
Level Of Evidence: Level III.
Mokhaberi N, Schneider E, Aftzoglou M, Huners I, Korner M, Armbrust L Pediatr Surg Int. 2024; 41(1):48.
PMID: 39725751 PMC: 11671421. DOI: 10.1007/s00383-024-05950-3.
Moschino L, Guiducci S, Duci M, Meggiolaro L, Nardo D, Bonadies L Children (Basel). 2024; 11(11).
PMID: 39594918 PMC: 11592962. DOI: 10.3390/children11111343.
Cuna A, Kumar N, Sampath V Front Pediatr. 2024; 12:1432808.
PMID: 39398415 PMC: 11466774. DOI: 10.3389/fped.2024.1432808.
Acquired colonic atresia in children: a report of three cases and review of the literature.
Fouad D, Bethell G, Hall N J Surg Case Rep. 2024; 2024(8):rjae012.
PMID: 39183790 PMC: 11342861. DOI: 10.1093/jscr/rjae012.
Zhang L, Lu W BMC Pediatr. 2024; 24(1):387.
PMID: 38851677 PMC: 11162010. DOI: 10.1186/s12887-024-04866-0.