Heterogeneity of necrotizing enterocolitis associated with congenital heart disease: a comparative study of preoperative and postoperative clinical phenotypes.

PURPOSE: To characterize the clinical differences between pre- and postoperative congenital heart disease (CHD)-associated necrotizing enterocolitis (CHD-NEC) and to explore whether these entities represent distinct clinical phenotypes.

METHODS

Patients with NEC episodes at our institution were retrospectively reviewed, and the NEC episodes were classified as classical NEC, preoperative CHD-NEC, or postoperative CHD-NEC. Clinical characteristics, clinical severity, laboratory data, detection triggers, and hemodynamic background at NEC onset were compared among groups. An exploratory subgroup analysis of postoperative CHD-NEC was performed.

RESULTS

This analysis included 55 NEC episodes in 47 infants, comprising 7 classical NEC, 15 preoperative CHD-NEC, and 33 postoperative CHD-NEC. Preoperative CHD-NEC was associated with a higher perforation rate (26.7% vs. 3.0%), a lower pH (7.35 vs. 7.44), higher lactate levels (26.5 vs. 11.5 mg/dL), and lower antithrombin III levels (51.0% vs. 81.0%) compared with postoperative CHD-NEC. Postoperative CHD-NEC was more often detected on imaging findings, including portal venous gas on ultrasonography (24.2% vs. 0.0%). Meanwhile, preoperative CHD-NEC was more often identified after the onset of a bloody stool (80.0% vs. 42.4%).

CONCLUSION

CHD-NEC may not be a uniform entity. However, preoperative CHD-NEC and postoperative CHD-NEC differ in terms of clinical severity, detection patterns, and hemodynamic background.