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Necrotising enterocolitis in infants with congenital heart disease: the role of enteral feeds

Published online by Cambridge University Press:  02 October 2012

Glen J. Iannucci ,
Matthew E. Oster  and
William T. Mahle
Glen J. Iannucci*
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
Matthew E. Oster
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
William T. Mahle
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
*
Correspondence to: Dr G. Iannucci, MD, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, GA 30322-1062, United States of America. Tel: +1 404 256 2593; Fax: +1 770 488 9013; E-mail: iannuccig@kidsheart.com
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Abstract

Objective

Necrotising enterocolitis is a rare, though catastrophic complication that may occur in term newborns with congenital heart disease. There is considerable controversy regarding the factors that lead to necrotising enterocolitis in this population. We sought to determine the incidence of necrotising enterocolitis among term and near-term newborns with congenital heart disease, focusing on the relationship of enteral feeding to this complication.

Methods

In this retrospective study, we identified the incidence of necrotising enterocolitis among 1551 newborns admitted to our cardiac intensive care unit between July 1, 2002 and July 1, 2010. In order to understand the impact of enteral feeding upon the development of necrotising enterocolitis, we undertook a nested 2:1 matched case–control analysis to compare feeding patterns in an age- and lesion-matched control population.

Results

Necrotising enterocolitis developed in 45 term or near-term infants (3%). The majority of these cases, 27 (60%), occurred in the post-operative period after the introduction of enteral feeds. This subgroup was used for matched analysis. There were no differences in enteral feeding patterns among the patients who developed necrotising enterocolitis and their matched controls. The overall mortality rate for patients who developed necrotising enterocolitis was 24.4% (11 out of 45).

Conclusions

Despite numerous advances in the care of infants with congenital heart disease, necrotising enterocolitis remains a significant source of morbidity and mortality. In these infants, there is no clear relationship between enteral feeding patterns and the development of necrotising enterocolitis in the post-operative period. The benefits of graduated feeding advancements to avoid the development of necrotising enterocolitis remain unproven.

Keywords

Congenital heart diseasenecrotising enterocolitisenteral feedingcongenital heart surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 4 , August 2013 , pp. 553 - 559
Copyright
Copyright © Cambridge University Press 2012 

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