Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T01:51:06.307Z Has data issue: false hasContentIssue false
  • English
  • Français

Necrotising enterocolitis in infants with congenital heart disease: the role of enteral feeds

Published online by Cambridge University Press:  02 October 2012

Glen J. Iannucci ,
Matthew E. Oster  and
William T. Mahle
Glen J. Iannucci*
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
Matthew E. Oster
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
William T. Mahle
Affiliation:
Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
*
Correspondence to: Dr G. Iannucci, MD, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, GA 30322-1062, United States of America. Tel: +1 404 256 2593; Fax: +1 770 488 9013; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Necrotising enterocolitis is a rare, though catastrophic complication that may occur in term newborns with congenital heart disease. There is considerable controversy regarding the factors that lead to necrotising enterocolitis in this population. We sought to determine the incidence of necrotising enterocolitis among term and near-term newborns with congenital heart disease, focusing on the relationship of enteral feeding to this complication.

Methods

In this retrospective study, we identified the incidence of necrotising enterocolitis among 1551 newborns admitted to our cardiac intensive care unit between July 1, 2002 and July 1, 2010. In order to understand the impact of enteral feeding upon the development of necrotising enterocolitis, we undertook a nested 2:1 matched case–control analysis to compare feeding patterns in an age- and lesion-matched control population.

Results

Necrotising enterocolitis developed in 45 term or near-term infants (3%). The majority of these cases, 27 (60%), occurred in the post-operative period after the introduction of enteral feeds. This subgroup was used for matched analysis. There were no differences in enteral feeding patterns among the patients who developed necrotising enterocolitis and their matched controls. The overall mortality rate for patients who developed necrotising enterocolitis was 24.4% (11 out of 45).

Conclusions

Despite numerous advances in the care of infants with congenital heart disease, necrotising enterocolitis remains a significant source of morbidity and mortality. In these infants, there is no clear relationship between enteral feeding patterns and the development of necrotising enterocolitis in the post-operative period. The benefits of graduated feeding advancements to avoid the development of necrotising enterocolitis remain unproven.

Keywords

Congenital heart diseasenecrotising enterocolitisenteral feedingcongenital heart surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 4 , August 2013 , pp. 553 - 559
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hsueh, W, Caplan, MS, Qu, X-W, et al. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003; 6: 6–23.CrossRefGoogle ScholarPubMed
2. McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.Google Scholar
3. Leung, MP, Chau, KT, Hui, PW, et al. Necrotizing enterocolitis in neonates with symptomatic congenital heart disease. J Pediatr 1988; 113: 1044–1046.CrossRefGoogle ScholarPubMed
4. 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: 389–392.CrossRefGoogle Scholar
5. Lin, PW, Stoll, BJ. Necrotising enterocolitis. Lancet 2006; 368: 1271–1283.CrossRefGoogle ScholarPubMed
6. del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373–377.Google ScholarPubMed
7. Jeffries, HE, Wells, WJ, Starnes, VA, et al. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2006; 81: 982–987.CrossRefGoogle ScholarPubMed
8. Berseth, CL. Feeding strategies and necrotizing enterocolitis. Curr Opin Pediatr 2005; 17: 170–173.Google Scholar
9. 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: 330–335.CrossRefGoogle ScholarPubMed
10. Cheung, Y-f, Ho, MHK, Cheng, VYW. Mesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation. Ann Thorac Surg 2003; 75: 947–951.CrossRefGoogle ScholarPubMed
11. 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 CritCare Med 2006; 7: 132–137.CrossRefGoogle ScholarPubMed
12. Medoff-Cooper, B, Irving, SY. Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19 (Suppl 2): 90–95.CrossRefGoogle ScholarPubMed
13. Pillo-Blocka, F, Adatia, I, Sharieff, W, et al. Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial. J Pediatr 2004; 145: 761–766.CrossRefGoogle ScholarPubMed
14. Kliegman, RM, Walsh, MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17: 213–288.Google Scholar
15. Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
16. Pickard, SS, Feinstein, JA, Popat, RA, et al. Short- and long-term outcomes of necrotizing enterocolitis in infants with congenital heart disease. Pediatrics 2009; 123: e901–e906.CrossRefGoogle Scholar
17. Cheng, W, Leung, MP, Tam, PK. Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease. Pediatr Surg Int 1999; 15: 492–495.Google Scholar
18. Torres, A Jr. To (enterally) feed or not to feed (the infant with hypoplastic left heart syndrome) is no longer the question. Pediatr Crit Care Med 2010; 11: 431–432.Google Scholar
19. Morgan, J, Young, L, McGuire, W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2011, CD001970.Google ScholarPubMed
20. Morgan, J, Young, L, McGuire, W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2011, CD001241.Google ScholarPubMed
21. Howley, LW, Kaufman, J, Wymore, E, et al. Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice. Cardiol Young 2011: 1–7.Google ScholarPubMed
22. Johnson, B, Mussatto, K, Uhing, M, et al. Variability in the preoperative management of infants with hypoplastic left heart syndrome. Pediatr Cardiol 2008; 29: 515–520.CrossRefGoogle ScholarPubMed
23. Willis, L, Thureen, P, Kaufman, J, et al. Enteral feeding in prostaglandin-dependent neonates: is it a safe practice? J Pediatr 2008; 153: 867–869.CrossRefGoogle ScholarPubMed
24. Natarajan, G, Reddy Anne, S, Aggarwal, S. Enteral feeding of neonates with congenital heart disease. Neonatology 2010; 98: 330–336.CrossRefGoogle ScholarPubMed
25. Kelleher, DK, Laussen, P, Teixeira-Pinto, A, et al. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237–244.Google Scholar
26. Gillespie, M, Kuijpers, M, Van Rossem, M, et al. Determinants of intensive care unit length of stay for infants undergoing cardiac surgery. Congenit Heart Dis 2006; 1: 152–160.Google Scholar
27. Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495–501.CrossRefGoogle ScholarPubMed
28. Braudis, NJ, Curley, MAQ, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460–466.Google Scholar
29. Malagon, I, Onkenhout, W, Klok, G, et al. Gut permeability in paediatric cardiac surgery. Br J Anaesth 2005; 94: 181–185.Google Scholar
30. Dees, E, Lin, H, Cotton, RB, et al. Outcome of preterm infants with congenital heart disease. J Pediatr 2000; 137: 653–659.CrossRefGoogle ScholarPubMed
31. Medoff-Cooper, B, Irving, SY, Marino, BS, et al. Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge. Cardiol Young 2011; 21: 136–144.Google Scholar
32. Schwalbe-Terilli, CR, Hartman, DH, Nagle, ML, et al. Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 2009; 18: 52–57.Google Scholar