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Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study
  1. Kajsa Nordenström1,2,
  2. Katarina Lannering1,3,
  3. Mats Mellander1,3,
  4. Anders Elfvin1,2
  1. 1Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
  2. 2Department of Pediatrics, Sahlgrenska University Hospital, Goteborg, Sweden
  3. 3Pediatric Heart Center, Sahlgrenska University Hospital, Goteborg, Sweden
  1. Correspondence to Dr Anders Elfvin, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg 416 85, Sweden; anders.elfvin{at}


Objective We aimed to investigate the frequency of necrotising enterocolitis (NEC) in infants with critical congenital heart disease (CCHD) hypothesising that preoperative enteral feeding does not increase the risk of NEC.

Background When NEC affects term infants, underlying risk factors such as asphyxia, sepsis or CCHD are often found. Due to fear of NEC development in infants with CCHD great caution is practised in many countries to defer preoperative enteral feeding, but in Sweden this is routinely provided.

Design, setting and patients An observational study of all infants born with CCHD who were admitted to Queen Silvia Children’s Hospital in Gothenburg between 2010 and 2017. The International Classification of Diseases 10th Revision diagnosis code of NEC was used to identify NEC cases in this group. Infants described as ‘fully fed’ or who were fed at least 45 mL/kg/day before cardiac surgery were identified.

Main outcome measures NEC in infants with CCHD in relation to preoperative enteral feeding.

Results There were 458 infants with CCHD admitted during the study period. 408/458 were born at term and 361/458 required prostaglandin E1 before surgery. In total, 444/458 infants (97%) were fully fed or fed at least 45 mL/kg daily before cardiac surgery. Four of 458 infants developed NEC (0.9%). All four had other risk factors for NEC.

Conclusions This study showed a low risk of NEC in term infants fed enterally before cardiac surgery. We speculate that preoperative enteral feeding of neonates with CCHD does not increase the risk of NEC development.

  • neonatology
  • cardiac surgery
  • cardiology
  • paediatric surgery
  • infant feeding

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  • Contributors MM and AE conceptualised and designed the study, advised on the data analysis and interpretation of results, and reviewed and revised the manuscript. KN carried out the study design and data collection and analysis and drafted the initial manuscript. KL contributed to drafting the study design and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This study was partly financed by Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, Department of Pediatrics, Gothenburg, Sweden. It was also financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (117661). MM was supported by the Swedish Heart and Lung Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Ethical Review Board in Gothenburg (study code T714-17).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified data will be available upon reasonable request. Data are kept at a repository. Contact details: Anders Elfvin, Phone:+46313438073.

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