Worse outcomes and distinct clinical features in infants with necrotizing enterocolitis and congenital heart disease.

OBJECTIVE

This study aimed to compare the clinical characteristics and outcomes in infants with necrotizing enterocolitis (NEC) with and without congenital heart disease (CHD) and to further evaluate the impact of isolated patent ductus arteriosus (PDA) on NEC severity.

METHODS

A retrospective cohort study involving 165 infants diagnosed with NEC at our center from January 2015 to April 2025 was conducted. Patients were stratified into two groups: those with CHD (n=75) and those without CHD (n=90). Demographic, clinical, laboratory, and outcome data were collected. Intergroup comparisons were performed using nonparametric and chi-square tests. Univariate and multivariate logistic regression analyses were employed to identify factors associated with severe outcomes.

RESULTS

Compared with infants without CHD, infants with CHD had significantly younger gestational ages (median [IQR]: 30.2 [28.5-32.1] vs. 32.5 [31.0-34.0] weeks, P<0.01) and birth weights (1250 [980-1500] vs. 1580 [1350-1820] grams, P<0.01), longer durations of respiratory support (15 [10-25] vs. 8 [5-12] days, P<0.01), longer hospital stays (45 [35-60] vs. 32 [25-40] days, P<0.01), and greater mortality (28.0% vs. 11.1%, P<0.01). Notably, the severity of NEC (Bell's stage II/III) did not differ significantly between infants with isolated PDA and those with other forms of CHD (65% vs. 68%, P=0.82). Multivariate analysis revealed lower serum albumin levels and thrombocytopenia at onset as potential early indicators for adverse outcomes in the CHD group.

CONCLUSIONS

NEC in infants with CHD is associated with a more severe clinical course and poorer prognosis. Compared with other CHD types, the presence of isolated PDA does not confer an additional risk for more severe NEC.