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Suspected necrotising enterocolitis after surgery for CHD: an opportunity to improve practice and outcomes

Published online by Cambridge University Press:  07 February 2018

Eleanor L. Schuchardt Open the ORCID record for Eleanor L. Schuchardt [Opens in a new window] ,
Jon Kaufman ,
Bridget Lucas ,
Kendra Tiernan ,
Suzanne Osorio Lujan  and
Cindy Barrett
Eleanor L. Schuchardt*
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
Jon Kaufman
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
Bridget Lucas
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
Kendra Tiernan
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
Suzanne Osorio Lujan
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
Cindy Barrett
Affiliation:
The Heart Institute, Children’s Hospital Colorado, Aurora, Colorado, USA
*
Author for correspondence: E. L. Schuchardt, The Heart Institute, Children's Hospital Colorado, 13123 East 16th Ave B-100, Aurora, CO 80045, United States of America. Tel: 720 777 2884; Fax: 720-777-7290; E-mail: Eleanor.Schuchardt@childrenscolorado.org
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Abstract

Infants with CHD are at increased risk of necrotising enterocolitis, which can interfere with the achievement of adequate nutrition and, ultimately, growth and development. Necrotising enterocolitis is classified by severity as suspected, confirmed, and advanced. We sought to quantify the incidence of all types of necrotising enterocolitis among infants who underwent surgery, with a particular focus on suspected necrotising enterocolitis. This is a retrospective review of all infants <6 months of age who underwent cardiac surgery during 2012 and 2013 at Children’s Hospital Colorado. We examined the hospital course of 265 hospitalisations (n=251 patients) and found 18 patients (19 hospitalisations) with suspected necrotising enterocolitis and 16 patients (16 hospitalisations) with confirmed or advanced necrotising enterocolitis. Single-ventricle physiology, lower weight, and younger age were associated with necrotising enterocolitis. Patients with all types of necrotising enterocolitis experienced prolonged length of hospital stay. We found suspected necrotising enterocolitis to be as common as confirmed necrotising enterocolitis, and it frequently occurred early in the post-operative course. We speculate that suspected necrotising enterocolitis may often be overlooked in research owing to a reliance on billing codes. Nevertheless, suspected necrotising enterocolitis poses a substantial barrier to post-operative progression of the CHD patient, as does confirmed necrotising enterocolitis. Following the diagnosis of all types of necrotising enterocolitis, there was wide variability in practice patterns. In response to this variability, we developed care guidelines for the diagnosis and treatment of necrotising enterocolitis in this population.

Keywords

Necrotising enterocolitiscongenital heart diseaseInfantscare guidelinequality improvementsuspected necrotising enterocolitis
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 639 - 646
Copyright
© Cambridge University Press 2018 

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References

1. Latal, B. Neurodevelopmental outcomes of the child with congenital heart disease. Clin Perinatol 2016; 43: 173–185.Google Scholar
2. Jacobs, ML, O’Brien, SM, Jacobs, JP, et al. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg 2013; 145: 1046–1057.e1.Google Scholar
3. Kaufman, J, Barrett, C. Moving beyond mortality: preservation of value, but at what cost? Pediatr Crit Care Med 2014; 15: 783–784.Google Scholar
4. McElhinney, D, Hedrick, H, Bush, D, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.Google Scholar
5. Kliegman, RM, Walsh, MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17: 213–288.Google Scholar
6. Giannone, P, Luce, W, Nankervis, C, Hoffman, T, Wold, L. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82: 341–347.Google Scholar
7. Pickard, S, Feinstein, J, Popat, R, Huang, L, Dutta, S. Short- and long-term outcomes of necrotizing enterocolitis in infants with congenital heart disease. Pediatrics 2009; 123: e901–e906. https://doi.org/10.1542/peds.2008-3216Google Scholar
8. Dewitt, A, Charpie, J, Donohue, J, Yu, S, Owens, G. Splanchnic near-infrared spectroscopy and risk of necrotizing enterocolitis after neonatal heart surgery. Pediatr Cardiol 2014; 35: 1286–1294.Google Scholar
9. Motta, C, Scott, W, Mahony, L, et al. The association of congenital heart disease with necrotizing enterocolitis in preterm infants: a birth cohort study. J Perinatol 2015; 35: 949–953.CrossRefGoogle ScholarPubMed
10. Kaufman, J, Vichayavilas, P, Rannie, M, et al. Improved nutrition delivery and nutrition status in critically ill children with heart disease. Pediatrics 2015; 135: e717–e725.Google Scholar
11. Scahill, CJ, Graham, EM, Atz, AM, Bradley, SM, Kavarana, MN, Zyblewski, SC. Preoperative Feeding in Neonates with Cardiac Disease. World J Pediatr Congenit Heart Surg 2017; 8: 62–68.CrossRefGoogle ScholarPubMed
12. Leung, MP, Chau, KT, Hui, PW, et al. Necrotizing enterocolitis in neonates with symptomatic congenital heart disease. J Pediatr 1988; 113: 1044–1046.Google Scholar
13. Jeffries HE, Well WJ, Starnes VA, Wetzel RC, Moromisato DY. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2006; 81: 982–987.Google Scholar
14. del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373–377.Google Scholar
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