Necrotizing enterocolitis and congenital heart disease: differences in management and prognosis.

OBJECTIVES

Necrotizing enterocolitis (NEC) is a main cause of neonatal morbimortality. Gut prematurity and ischemia-reperfusion injury contribute to NEC and characterize two different scenarios: prematurity and congenital cardiopathy (CC). Our aim is to investigate whether CC worsens NEC gastrointestinal and general prognosis.

MATERIALS AND

METHODS

NEC episodes from 2015-2023 were reviewed and classified into CC and non-CC. Patients with focal intestinal perforation were excluded. Data regarding NEC debut and management, surgical timing, intestinal segment involved and short-term outcomes were compared.

RESULTS

Out of 205 neonates, 15 were excluded for unavailable records or uncertain diagnosis. 190 cases were included, 59 with CC. Comparing CC and non-CC, no significant differences were found in weight or age at diagnosis, or NEC stage. Hemodynamic (HD) shock [38.98% vs 24.43% (p <  0.05)] and need for vasoactive support at debut were more frequent in CC patients [44.07% vs 23.66% (p < 0.05)]. No differences were found regarding need for surgery at debut, length of resected intestine or segment affected or days on parenteral nutrition. CC conditioned longer hospital stay [110.8 ± 68.4 days vs 68.4 ± 44.6 (p <  0.05)] and higher mortality [30.5 vs 11.5 (p <  0.05)].

CONCLUSIONS

NEC in CC patients presents more HD instability at debut and worse global prognosis, probably due to inherent cardiovascular compromise, but need for surgery, type of intestinal involvement and short-term outcomes are similar to non-CC NEC.