Serious Congenital Heart Disease and Necrotizing Enterocolitis in Very Low Birth Weight Neonates - 20/05/15

Doi : 10.1016/j.jamcollsurg.2014.11.026

Jeremy G. Fisher, MD ^a, Sigrid Bairdain, MD, MPH ^a, Eric A. Sparks, MD ^a, Faraz A. Khan, MD ^a, Jeremy M. Archer, MD, MS ^e, Michael Kenny, MS ^b, Erika M. Edwards, PhD, MPH ^b, Roger F. Soll, MD ^b,^c, Biren P. Modi, MD, FACS ^a, Scott Yeager, MD ^d, Jeffrey D. Horbar, MD ^b, Tom Jaksic, MD, PhD, FACS ^a,^⁎
^a Department of Surgery, Boston Children's Hospital, Boston, MA
^b Vermont Oxford Network, University of Vermont, Burlington, VT
^c Department of Pediatrics, University of Vermont, Burlington, VT
^d Division of Pediatric Cardiology, University of Vermont, Burlington, VT
^e Congenital Heart Center, University of Florida, Gainesville, FL and Billings Clinic, Billings, MT

^∗Correspondence address: Tom Jaksic, MD, PhD, FACS, 300 Longwood Ave, Fegan 3, Boston, MA 02115.

Abstract

Background

Infants with serious congenital heart disease (CHD) appear to be at increased risk for necrotizing enterocolitis (NEC). This study aimed to quantify the incidence and mortality of NEC among very low birth weight (VLBW) neonates with serious CHD, and identify specific CHD diagnoses at the highest risk for developing NEC.

Study Design

Data were prospectively collected on 257,794 VLBW (401 to 1,500 g) neonates born from 2006 to 2011 and admitted to 674 Vermont Oxford Network US centers. Entries were coded for specific CHD diagnoses and reviewed for completeness and consistency. Survival was defined as alive in-hospital at 1 year or discharge.

Results

Of eligible neonates, 1,931 had serious CHD. Of these, 253 (13%) developed NEC (vs 9% in infants without CHD, adjusted odds ratio [AOR] 1.80, p < 0.0001). Mortality for neonates with CHD and no NEC was 34%, vs 55% for those with CHD and NEC (p < 0.0001). Both groups of CHD patients had higher mortality than infants with NEC without CHD (28%, p < 0.0001). Although NEC mortality overall decreases with higher birth weight, mortality for NEC and CHD together does not.

Conclusions

The incidence of NEC is significantly higher in VLBW neonates when CHD is present. The mortality of CHD and NEC together is substantially higher than that with each disease alone. Infants with atrioventricular canal appear to have higher risk for developing NEC than other CHD diagnoses. In addition to providing benchmark incidence and mortality data, these findings may have utility in the further study of the pathophysiology of NEC.

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Abbreviations and Acronyms : AOR, AV, CHD, DORV, HLHS, NEC, VLBW, VON

Plan

	Disclosure Information: Nothing to disclose.
	Financial Disclosure: Drs Horbar and Soll are employees of the Vermont Oxford Network.
	The centers in the Vermont Oxford Network are listed in the Appendix, online only.