Clinical characterization of necrotizing enterocolitis in neonates with or without congenital heart disease: a case–control study

Abstract

Background

This study aimed to analyze the clinical characteristics and differences between neonates with congenital heart disease (CHD)–related neonatal necrotizing enterocolitis (NEC) and those with non-CHD–related neonatal NEC.

Method

This retrospective study included patients with CHD who met Bell’s staging diagnostic criteria and were hospitalized between 2014 and 2023 in the Cardiac Intensive Care Unit of Cardiothoracic Surgery, Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. These patients comprised the CHD-related NEC group (CHD-NEC group). Meanwhile, the control group included randomly matched non-CHD–related NEC children (nCHD-NEC group) admitted to the neonatal department of the Second People’s Hospital in Kashi Prefecture according to the 1:2 matching principle. Patients’ basic information, adverse clinical events before NEC onset as well as NEC severity and treatment were recorded.

Results

The CHD-NEC group comprised 60 cases, whereas the nCHD-NEC group comprised 120 cases. Compared with the nCHD-NEC group, the CHD-NEC group had an older gestational age (38.71 [37.89, 39.67] weeks vs. 30.65 [29.68, 32.29] weeks, p < 0.001); a heavier birth weight (3.2 [2.69, 3.67] kg vs. 1.39 [1.1, 1.59] kg, p < 0.001); and higher proportions of patent ductus arteriosus (73.3% vs. 26.7%, p < 0.001), shock (81.7% vs. 36.7%, p < 0.001), and mechanical ventilation requirement (91.7% vs. 51.7%, p < 0.001). At disease onset, the CHD-NEC group had a higher vasoactive drug score (16.75 [7.26, 23.63] vs. 0 [0, 10], p < 0.001) but lower values for the proportion of infants who were small for gestational age (15% vs. 33.3%, p = 0.045), incidence of premature rupture of membranes (3.3% vs. 26.7%, p = 0.002), incidence of early onset sepsis (6.7% vs. 23.3%, p = 0.038), and incidence of late onset sepsis (46.7% vs. 70%, p = 0.036) than the nCHD-NEC group. Among children who required abdominal surgery, the CHD-NEC group tended to have more colon involvement (6.6% vs. 0.8%, p = 0.063), but no significant difference in mortality was noted between the two groups.

Conclusion

Children with CHD-NEC and nCHD-NEC have significantly different clinical characteristics. CHD-NEC is mainly observed in full-term infants with appropriate weight for gestational age, and perioperative intestinal ischemia may be the main pathophysiology. Conversely, nCHD-NEC is mainly noted in preterm infants, possibly related to immature intestinal development and infection. Large prospective clinical research is warranted to explore the pathogenesis, pathophysiology, indicator monitoring, and treatment plan for children with NEC.