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Risk Factors for Adverse Outcomes in Term Infants with CHD and Definitive Necrotising Enterocolitis

Published online by Cambridge University Press:  25 May 2023

Anna M. Deitch ,
Katie Moynihan ,
Robert Przybylski ,
Kimberlee Gauvreau ,
Nancy J. Braudis ,
Bethany Farr ,
Biren Modi ,
Kimberly I. Mills ,
Meena Nathan Open the ORCID record for Meena Nathan [Opens in a new window]  and
Philip T. Levy Open the ORCID record for Philip T. Levy [Opens in a new window]
Anna M. Deitch
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA Department of Cardiology, Lucile Packard Children’s Hospital, Stanford, CA, USA
Katie Moynihan
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Robert Przybylski
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Kimberlee Gauvreau
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Nancy J. Braudis
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Bethany Farr
Affiliation:
Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Biren Modi
Affiliation:
Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Kimberly I. Mills
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Meena Nathan
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Philip T. Levy*
Affiliation:
Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
*
Corresponding author: Dr P. T. Levy; Email: philip.levy@childrens.harvard.edu
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Abstract

Objectives:

To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality.

Methods:

We performed a 20-year (2000–2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children’s Hospital cardiac ICU with necrotising enterocolitis (Bell’s stage ≥ II). The primary outcome was a composite of in-hospital mortality and post-necrotising enterocolitis morbidity (need for extracorporeal membrane oxygenation, multisystem organ failure based on the paediatric sequential organ failure assessment score, and/or need for acute gastrointestinal intervention). Predictors included patient characteristics, cardiac diagnosis/interventions, feeding regimen, and severity measures.

Results:

Of 3933 term infants with CHD, 2.1% (n = 82) developed necrotising enterocolitis, with 67% diagnosed post-cardiac intervention. Thirty (37%) met criteria for the primary outcome. In-hospital mortality occurred in 14 infants (17%), of which nine (11%) deaths were attributable to necrotising enterocolitis. Independent predictors of the primary outcome included moderate to severe systolic ventricular dysfunction (odds ratio 13.4,confidence intervals 1.13–159) and central line infections pre-necrotising enterocolitis diagnosis (odds ratio 17.7, confidence intervals 3.21–97.0) and mechanical ventilation post-necrotising enterocolitis diagnosis (odds ratio 13.5, confidence intervals 3.34–54.4). Single ventricle, ductal dependency, and feeding related factors were not independently associated with the primary outcome.

Conclusions:

The incidence of necrotising enterocolitis was 2.1% in term infants with CHD. Adverse outcomes occurred in greater than 30% of patients. Presence of systolic dysfunction and central line infections prior to diagnosis and need for mechanical ventilation after diagnosis of necrotising enterocolitis can inform risk triage and prognostic counseling for families.

Keywords

Necrotizing enterocolitiscongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 1 , January 2024 , pp. 92 - 100
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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