Newborn

Register      Login

VOLUME 1 , ISSUE 1 ( January-March, 2022 ) > List of Articles

REVIEW ARTICLE

Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article

Sriya Roychaudhuri, Gurpreet Grewal, Sakethram Saravu Vijayashankar, Pascal Lavoie

Keywords : Congenital heart disease, Necrotizing enterocolitis, Neonatal mortality, Preterm newborns

Citation Information : Roychaudhuri S, Grewal G, Vijayashankar SS, Lavoie P. Necrotizing Enterocolitis Associated with Congenital Heart Disease—A Review Article. 2022; 1 (1):170-176.

DOI: 10.5005/jp-journals-11002-0016

License: CC BY-NC 4.0

Published Online: 31-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Necrotizing enterocolitis (NEC) is a relatively rare but devastating entity associated classically with the preterm cohort in the neonatal intensive care unit. Preterm and term babies with congenital heart disease are at risk of a number of comorbidities because of the hemodynamic derangements due to a structurally abnormal heart and the corrective procedures adopted. Necrotizing enterocolitis is one of the dreaded complications associated with this cohort and impacts the course of these babies in the hospital in a major way. A large majority of term babies with NEC are in the backdrop of a significant congenital cardiac lesion. This review article summarizes the literature and elaborates this entity including its specific features, risk factors associated with its causality, histopathology and related aspects of hemodynamics, and feeding in this vulnerable population. It also provides insight into modifiable risk factors and early markers of detection of gut necrosis to facilitate prevention and early detection. It highlights the subtle but definite difference in outcome variables to help physicians enable the parents of babies with heart disease to develop a better understanding of the entity and its expected course while counseling.


HTML PDF Share
  1. Siano E, Lauriti G, Ceccanti S, et al. Cardiogenic Necrotizing Enterocolitis: A Clinically Distinct Entity from Classical Necrotizing Enterocolitis. Eur J Pediatr Surg 2019;29(1):14–22. DOI: 10.1055/s-0038-1668144.
  2. Carlo WF, Kimball TR, Michelfelder EC, et al. Persistent Diastolic Flow Reversal in Abdominal Aortic Doppler-Flow Profiles is Associated with an Increased Risk of Necrotizing Enterocolitis in Term Infants with Congenital Heart Disease. Pediatrics 2007;119(2):330–335. DOI: 10.1542/peds.2006-2640.
  3. Giannone PJ, Luce WA, Nankervis CA, et al. Necrotizing Enterocolitis in Neonates with Congenital Heart Disease. Life Sci 2008;82(7-8): 341–347. DOI: 10.1016/j.lfs.2007.09.036.
  4. McElhinney DB, Hedrick HL, Bush DM, et al. Necrotizing Enterocolitis in Neonates with Congenital Heart Disease: Risk Factors and Outcomes. Pediatrics 2000;106(5):1080–1087. DOI: 10.1542/peds.106.5.1080.
  5. Martini S, Beghetti I, Annunziata M, et al. Enteral Nutrition in Term Infants with Congenital Heart Disease: Knowledge Gaps and Future Directions to Improve Clinical Practice. Nutrients 2021;13(3). DOI: 10.3390/nu13030932.
  6. Polglase GR, Ong T, Hillman NH. Cardiovascular Alterations and Multiorgan Dysfunction After Birth Asphyxia. Clin Perinatol 2016;43(3):469–483. DOI: 10.1016/j.clp.2016.04.006.
  7. Scahill CJ, Graham EM, Atz AM, et al. Preoperative Feeding Neonates With Cardiac Disease. World J Pediatr Congenit Heart Surg 2017;8(1):62–68. DOI: 10.1177/2150135116668833.
  8. Lannucci GJ, Oster ME, Mahle WT. Necrotising Enterocolitis in Infants with Congenital Heart Disease: The Role of Enteral Feeds. Cardiol Young 2013;23(4):553–559. DOI: 10.1017/S1047951112001370.
  9. Lau PE, Cruz SM, Ocampo EC, et al. Necrotizing Enterocolitis in Patients with Congenital Heart Disease: A Single Center Experience. J Pediatr Surg 2018;53(5):914–917. DOI: 10.1016/j.jpedsurg.2018.02.014.
  10. Mukherjee D, Zhang Y, Chang DC, et al. Outcomes analysis of necrotizing enterocolitis within 11 958 neonates undergoing cardiac surgical procedures. Arch Surg 2010;145(4):389–392. DOI: 10.1001/archsurg.2010.39.
  11. Neu J, Walker WA. Necrotizing Enterocolitis. N Engl J Med 2011;364(3):255–264. DOI: 10.1056/NEJMra1005408.
  12. Diez S, Tielesch L, Weiss C, et al. Clinical Characteristics of Necrotizing Enterocolitis in Preterm Patients With and Without Persistent Ductus Arteriosus and in Patients With Congenital Heart Disease. Front Pediatr 2020;8:257. DOI: 10.3389/fped.2020.00257.
  13. Weston C, Husain SA, Curzon CL, et al. Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage. Nurs Res Pract 2016;2016:9505629. DOI: 10.1155/2016/9505629.
  14. Becker KC, Hornik CP, Cotten CM, et al. Necrotizing Enterocolitis in Infants with Ductal-Dependent Congenital Heart Disease. Am J Perinatol 2015;32(7):633–638. DOI: 10.1055/s-0034-1390349.
  15. Kelleher ST, McMahon CJ, James A. Necrotizing Enterocolitis in Children with Congenital Heart Disease: A Literature Review. Pediatr Cardiol 2021. 42(8):1688–1699. DOI: 10.1007/s00246-021-02691-1
  16. Necrotizing enterocolitis in the premature infant. Br Med J 1966;2(5522):1089–1090. DOI: 10.1136/bmj.2.5522.1089-a.
  17. Carpenito KR, Prusinski R, Kirchner K, et al. Erratum to: Results of a Feeding Protocol in Patients Undergoing the Hybrid Procedure. Pediatr Cardiol 2016;37(5):991. Available from: https://doi.org/10.1007/s00246-016-1359-x
  18. ElHassan NO, Tang X, Gossett J, et al. Necrotizing Enterocolitis in Infants with Hypoplastic Left Heart Syndrome Following Stage 1 Palliation or Heart Transplant. Pediatr Cardiol 2018;39(4):774–785.Available from: https://doi.org/10.1007/s00246-018-1820-0
  19. Baxi AC, Josephson CD, Iannucci GJ, et al. Necrotizing Enterocolitis in Infants with Congenital Heart Disease: The Role of Red Blood Cell Transfusions. Pediatr Cardiol 2014;35(6):1024–1029. Available from: https://doi.org/10.1007/s00246-014-0891-9
  20. Song WS, Kim CY, Lee BS, et al. Morbidity and Mortality of Very Low Birth Weight Infants with Congenital Heart Disease. Korean Circ J 2020;50(12):1113–1123. DOI: 10.4070/kcj.2020.0135.
  21. Schuchardt EL, Kaufman J, Lucas B, et al. Suspected Necrotising Enterocolitis After Surgery for CHD: An Opportunity To Improve Practice and Outcomes. Cardiol Young 2018;28(5):639–646. DOI: 10.1017/S1047951117002815.
  22. Sharma R, Hudak ML. A Clinical Perspective of Necrotizing Enterocolitis: Past, Present, and Future. Clin Perinatol 2013;40(1):27–51. DOI: 10.1016/j.clp.2012.12.012.
  23. Bubberman JM, van Zoonen A, Bruggink JLM, et al. Necrotizing Enterocolitis Associated with Congenital Heart Disease: a Different Entity? J Pediatr Surg 2019;54(9):1755–1760. Available from: https://doi.org/10.1016/j.jpedsurg.2018.11.012
  24. Canesin WC, Volpe FAP, Goncalves-Ferri WA, et al. Primary Peritoneal Drainage in Neonates with Necrotizing Enterocolitis Associated with Congenital Heart Disease: A Single Experience in a Brazilian Tertiary Center. Braz J Med Biol Res 2021;54(9):e10220. DOI: 10.1590/1414-431X2020e10220.
  25. Cheung PY, Hajihosseini M, Dinu IA, et al. Outcomes of Preterm Infants With Congenital Heart Defects After Early Surgery: Defining Risk Factors at Different Time Points During Hospitalization. Front Pediatr 2020;8:616659. DOI: 10.3389/fped.2020.616659.
  26. Hasegawa T, Yoshioka Y, Sasaki T, et al. Necrotizing Enterocolitis in a Term Infant with Coarctation of the Aorta Complex. Pediatr Surg Int 1997;12(1):57–58. DOI: 10.1007/BF01194804.
  27. van der Heide M, Mebius MJ, Bos AF, et al. Hypoxic/Ischemic Hits Predispose to Necrotizing Enterocolitis in (near) Term Infants with Congenital Heart Disease: A Case Control Study. BMC Pediatr 2020;20(1):553. Available from: https://doi.org/10.1186/s12887-020-02446-6
  28. Klinke M, Wiskemann H, Bay B, et al. Cardiac and Inflammatory Necrotizing Enterocolitis in Newborns Are Not the Same Entity. Front Pediatr 2020;8:593926. DOI: 10.3389/fped.2020.593926.
  29. Cozzi C, Aldrink J, Nicol K, et al. Intestinal Location of Necrotizing Enterocolitis Among Infants With Congenital Heart Disease. J Perinatol 2013;33(10):783–785. DOI: 10.1038/jp.2013.49.
  30. Gephart SM, Moore EF, Fry E. Standardized Feeding Protocols to Reduce Risk of Necrotizing Enterocolitis in Fragile Infants Born Premature or with Congenital Heart Disease: Implementation Science Needed. Crit Care Nurs Clin North Am 2018;30(4):457–466. DOI: 10.1016/j.cnc.2018.07.003.
  31. Miller TA, Minich LL, Lambert LM, et al. Abnormal Abdominal Aorta Hemodynamics Are Associated With Necrotizing Enterocolitis in Infants with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2014;35(4):616–621. DOI: 10.1007/s00246-013-0828-8.
  32. Lopez SL, Taeusch HW, Findlay RD, et al. Time of Onset of Necrotizing Enterocolitis in Newborn Infants With Known Prenatal Cocaine Exposure. Clin Pediatr (Phila) 1995;34(8):424–429. DOI: 10.1177/000992289503400805.
  33. Bain J, Benjamin DK, Jr., Hornik CP, et al. Risk of Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants with Isolated Atrial and Ventricular Septal Defects. J Perinatol 2014;34(4):319–321. DOI: 10.1038/jp.2013.174.
  34. del Castillo SL, Moromisato DY, Dorey F, et al. Mesenteric Blood Flow Velocities in the Newborn with Single-Ventricle Physiology: Modified Blalock-Taussig Shunt Versus Right Ventricle-Pulmonary Artery Conduit. Pediatr Crit Care Med 2006;7(2):132–137. DOI: 10.1097/01.PCC.0000200999.89777.92.
  35. Harkin P, Marttila R, Pokka T, et al. Morbidities Associated with Patent Ductus Arteriosus In Preterm Infants. Nationwide Cohort Study. J Matern Fetal Neonatal Med 2018;31(19):2576–2583. Available from: https://doi.org/10.1080/14767058.2017.1347921
  36. Jenkins KJ. Risk Adjustment for Congenital Heart Surgery: The RACHS-1 Method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004;7:180–184. DOI: 10.1053/j.pcsu.2004.02.009.
  37. Motta C, Scott W, Mahony L, et al. The Association of Congenital Heart Disease with Necrotizing Enterocolitis in Preterm Infants: A Birth Cohort Study. J Perinatol 2015;35(11):949–953. Available from: http://dx.doi.org/10.1038/jp.2015.96
  38. Ferguson LP, Gandiya T, Kaselas C, et al. Gastrointestinal Complications Associated with the Surgical Treatment of Heart Disease in Children. J Pediatr Surg 2017;52(3):414–419. Available from: https://doi.org/10.1016/j.jpedsurg.2016.10.052
  39. Lu Q, Cheng S, Zhou M, et al. Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study. Pediatr Neonatol 2017;58(2):165–1670. DOI: 10.1016/j.pedneo.2016.04.002.
  40. Papneja K, Laks J, Szabo AB, et al. Low Descending Aorta Flow Is Associated With Adverse Feeding Outcomes in Neonates with Small Left-Sided Structures. Int J Cardiovasc Imaging 2021;37(1):269–273. DOI: 10.1007/s10554-020-01958-7.
  41. Cheung YF, Ho MH, Cheng VY. Mesenteric Blood Flow Response to Feeding After Systemic-To-Pulmonary Arterial Shunt Palliation. Ann Thorac Surg 2003;75(3):947–951. DOI: 10.1016/s0003-4975(02) 04627-1.
  42. Johnson JN, Ansong AK, Li JS, et al. Celiac Artery Flow Pattern in Infants with Single Right Ventricle Following the Norwood Procedure with a Modified Blalock-Taussig or Right Ventricle to Pulmonary Artery Shunt. Pediatr Cardiol 2011;32(4):479–486. DOI: 10.1007/s00246-011- 9906-y.
  43. Miller MJ, Clark DA. Congenital Heart Disease and Necrotizing Enterocolitis. J Pediatr 1989;115(2):335–356. Available from: https://doi.org/10.1016/S0022-3476(89)80108-8
  44. Sharma MS, Guleserian KJ, Forbess JM. Ladd's Procedure in Functional Single Ventricle and Heterotaxy Syndrome: Does Timing Affect Outcome? Ann Thorac Surg 2013;95(4):1403–1407; discussion 7–8. DOI: 10.1016/j.athoracsur.2012.11.018.
  45. Lopez NL, Gowda C, Backes CH, et al. Differences in Midterm Outcomes in Infants with Hypoplastic Left Heart Syndrome Diagnosed with Necrotizing Enterocolitis: NPCQIC Database Analysis. Congenit Heart Dis 2018;13(4):512–518. DOI: 10.1111/chd.12602.
  46. Kargl S, Maier R, Gitter R, et al. Necrotizing Enterocolitis After Open Cardiac Surgery for Congenital Heart Defects--A Serious Threat. Klin Padiatr 2013;225(1):24–28. DOI: 10.1055/s-0032-1331724.
  47. DeWitt AG, Charpie JR, Donohue JE, et al. Splanchnic Near-Infrared Spectroscopy and Risk of Necrotizing Enterocolitis After Neonatal Heart Surgery. Pediatr Cardiol 2014;35(7):1286–1294. DOI: 10.1007/s00246-014-0931-5.
  48. Weiss SL, Gossett JG, Kaushal S, et al. Comparison of Gastrointestinal Morbidity after Norwood and Hybrid Palliation for Complex Heart Defects. Pediatr Cardiol 2011;32(4):391–398. DOI: 10.1007/s00246-010-9864-9.
  49. O'Connor G, Brown KL, Taylor AM. Faecal Calprotectin Concentrations in Neonates with CHD: Pilot Study. Cardiol Young 2020;30(5):624–628. DOI: 10.1017/S1047951120000645.
  50. Golbus JR, Wojcik BM, Charpie JR, et al. Feeding Complications in Hypoplastic Left Heart Syndrome after the Norwood Procedure: A Systematic Review of the Literature. Pediatr Cardiol 2011;32(4): 539–552. DOI: 10.1007/s00246-011-9907-x.
  51. Cognata A, Kataria-Hale J, Griffiths P, et al. Human Milk Use in the Preoperative Period Is Associated with a Lower Risk for Necrotizing Enterocolitis in Neonates with Complex Congenital Heart Disease. J Pediatr 2019;215:11–6 e2. DOI: 10.1016/j.jpeds.2019.08.009.
  52. Cuna AC, Lee JC, Robinson AL, et al. Bowel Ultrasound for the Diagnosis of Necrotizing Enterocolitis: A Meta-analysis. Ultrasound Q 2018;34(3):113–118. DOI: 10.1097/RUQ.0000000000000342.
  53. Gunadi, Sirait DN, Fauzi AR, et al. Challenge in Diagnosis of Late Onset Necrotizing Enterocolitis in a Term Infant: A Case Report. BioMed Central Pediatr 2021;21(1):152. Available from: https://doi.org/10.1186/s12887-021-02626-y
  54. Watson JD, Urban TT, Tong SS, et al. Immediate Post-operative Enterocyte Injury, as Determined by Increased Circulating Intestinal Fatty Acid Binding Protein, Is Associated With Subsequent Development of Necrotizing Enterocolitis After Infant Cardiothoracic Surgery. Front Pediatr 2020;8:267. DOI: 10.3389/fped. 2020.00267.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.