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Serious Congenital Heart Disease and Necrotizing Enterocolitis in Very Low Birth Weight Neonates: A Prospective Cohort Analysis?
Jeremy G. Fisher1, Sigrid Bairdain1, Eric A. Sparks1, Faraz A Khan1, Jeremy Archer3, Michael Kenny2, Erika Edwards2, Roger Soll2,4, Biren P. Modi1, Scott Yeager5, Jeffrey Horbar2, Tom Jaksic1
1Department of Surgery, Boston Children’s Hospital, Boston, MA; 2Vermont Oxford Network, Burlington, VT; 3Congenital Heart Center, University of Florida, Gainesville, FL and Billings Clinic, Billings, MT; 4Department of Pediatrics, University of Vermont, Burlington, VT; 5Division of Pediatric Cardiology, University of Vermont, Burlington, VT

Objective: Infants with serious congenital heart disease (CHD) appear to be at increased risk for necrotizing enter colitis (NEC). The aims of this study were to: (1) quantify the incidence and mortality of NEC among very low birth weight (VLBW) neonates with serious CHD, and (2) identify specific CHD diagnoses at the highest risk for developing NEC.

Design: Prospective cohort study

Setting: 674 US NICUs participating in the Vermont Oxford Network

Patients: 257,794 VLBW (<1500g) neonates

Main Outcome Measure(s): Mortality with survival defined as alive in-hospital at one year or discharge

Results: Of eligible VLBW neonates, 1,931 had serious CHD. Among CHD patients, 253 (13%) developed NEC. There were 20,989 without CHD who developed NEC (incidence 9%, versus CHD: OR 2.01, 95% CI 1.71 to 2.36, P<0.0001). Mortality for neonates with CHD and no NEC was 34%, compared with 55% for those with CHD and NEC (P<0.0001). Both groups of CHD patients had higher mortality than those with NEC without CHD, 28% (P<0.0001). While NEC mortality overall improves with increasing birth weight, mortality for NEC and CHD together does not. Among CHD diagnoses, infants with complex systemic defects and complete atrioventricular (AV) canal had the highest significant risk for developing NEC.

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 each disease alone. Infants with complex systemic defects and AV canal appear to have the highest risk for developing NEC. 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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