Necrotizing Enterocolitis and Associated Mortality in Neonates With Congenital Heart Disease: A Multi-Institutional Study

Spinner JA, Morris SA, Nandi D, Costarino AT, Marino BS, Rossano JW, Shamszad P.
Pediatr Crit Care Med. 2019 Sep 20. doi: 10.1097/PCC.0000000000002133. [Epub ahead of print] PMID: 31568264
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Take-Home Points:

  • The prevalence of NEC in neonates with congenital heart disease is 3.7 %.
  • Hypoplastic Left Heart Syndrome and TA were the two cardiac lesions associated with the highest frequency of NEC. The odds of developing NEC were 2.7 and 2.6 times when compared to the lesion with the lowest incidence of NEC, that is Transposition of great arteries.
  • Adjusted risk factors associated with the development of NEC included prematurity, male sex, AA race, GI abnormality, and additional birth defects.
  • The overall hospital mortality of neonates with CHD and NEC was significantly higher than compared to neonates with CHD  and no NEC.
  • NEC was also associated with increased total hospital charges, longer ICU LOS and hospital LOS when compared to those without NEC and the association remained significant when analyzed by the individual cardiac defect.
  • No association was found with a 30-day readmission rate.


Commentary from Dr. Venugopal Amula (Salt Lake City, UT), section editor of Pediatric Cardiology Journal Watch:  This is a retrospective multi-institutional study describing the prevalence and mortality of necrotizing enterocolitis (NEC) in neonates with congenital heart disease. The Pediatric Health Information System database was queried for all index hospitalizations involving neonates with CHD between 2004 to 2015 and the primary outcome was the presence of NEC during the index hospitalization. Secondary outcomes studied included in-hospital mortality, hospital LOS, ICU LOS, hospital charges and 30-day readmission. Multivariable analysis for the presence of NEC and in-hospital mortality were performed for each heart defect category utilizing generalized estimating equations to adjust for hospital clustering. The heart defect categories included Single ventricle, Tricuspid atresia (TA), Truncus arteriosus, Transposition of great arteries, Tetralogy of Fallot and isolated arch obstruction. Variables included in the multivariable model for the presence of NEC were prematurity, African American race, male sex, additional birth defect or GI anomaly.