Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity?

J M Bubberman; A van Zoonen; J L M Bruggink; M van der Heide; R M F Berger; A F Bos; E M W Kooi; J B F Hulscher

doi:10.1016/j.jpedsurg.2018.11.012

Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity?

J M Bubberman, A van Zoonen, J L M Bruggink, M van der Heide, R M F Berger, A F Bos, E M W Kooi, J B F Hulscher

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Abstract

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 [52-189.0], 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.

Original language	English
Pages (from-to)	1755-1760
Number of pages	6
Journal	Journal of Pediatric Surgery
Volume	54
Issue number	9
Early online date	13-Dec-2018
DOIs	https://doi.org/10.1016/j.jpedsurg.2018.11.012
Publication status	Published - Sept-2019

Keywords

Necrotising enterocolitis
NEC
Prematurity
Congenital heart disease
CHD
RIGHT COLON
MORTALITY
ISCHEMIA
INFANTS
RISK

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@article{21ee9e4db4bd4fd09901b40990d6bb2b,

title = "Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity?",

abstract = "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 [52-189.0], 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. (C) 2018 Elsevier Inc. All rights reserved.",

keywords = "Necrotising enterocolitis, NEC, Prematurity, Congenital heart disease, CHD, RIGHT COLON, MORTALITY, ISCHEMIA, INFANTS, RISK",

author = "Bubberman, {J M} and {van Zoonen}, A and Bruggink, {J L M} and {van der Heide}, M and Berger, {R M F} and Bos, {A F} and Kooi, {E M W} and Hulscher, {J B F}",

year = "2019",

month = sep,

doi = "10.1016/j.jpedsurg.2018.11.012",

language = "English",

volume = "54",

pages = "1755--1760",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W B SAUNDERS CO-ELSEVIER INC",

number = "9",

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T1 - Necrotizing Enterocolitis Associated with Congenital Heart Disease

T2 - a Different Entity?

AU - Bubberman, J M

AU - van Zoonen, A

AU - Bruggink, J L M

AU - van der Heide, M

AU - Berger, R M F

AU - Bos, A F

AU - Kooi, E M W

AU - Hulscher, J B F

PY - 2019/9

Y1 - 2019/9

N2 - 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 [52-189.0], 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. (C) 2018 Elsevier Inc. All rights reserved.

AB - 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 [52-189.0], 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. (C) 2018 Elsevier Inc. All rights reserved.

KW - Necrotising enterocolitis

KW - NEC

KW - Prematurity

KW - Congenital heart disease

KW - CHD

KW - RIGHT COLON

KW - MORTALITY

KW - ISCHEMIA

KW - INFANTS

KW - RISK

U2 - 10.1016/j.jpedsurg.2018.11.012

DO - 10.1016/j.jpedsurg.2018.11.012

M3 - Article

C2 - 30635129

SN - 0022-3468

VL - 54

SP - 1755

EP - 1760

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

IS - 9

ER -

Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity?

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