Friday, June 12, 2009

Friday June 12, 2009 (pediatric pearl)
Necrotizing enterocolitis in children with cardiac disease is a unique and distinct entity

Necrotizing enterocolitis (NEC) is a disease predominantly of preterm neonates. The intestinal injury of NEC occurs in association with pathogenic enteric bacteria and leads to bowel ischemia, necrosis, perforation, sepsis, and, in severe cases, death. Although prematurity and the associated immaturity of the gut mucosa account for 90% of cases, 10% of NEC occurs in term infants.

There is a 10- to 100-fold increased risk of NEC in the population with CHD compared with the entire preterm and term neonatal population. Episodic or chronic decreased mesenteric perfusion with CHD contributes to the development of this clinical picture in the term infant.

Differences in initial severity, range of age at diagnosis, and prognoses between subjects with necrotizing enterocolitis with and without cardiac disease suggest that necrotizing enterocolitis in the cardiac patient is a distinct disease process and should be labeled cardiogenic necrotizing enterocolitis.

When controlling for birth weight and gestational age, the congenital heart disease group had decreased risk of perforation, need for a bowel operation, strictures, need for a stoma, sepsis, and short bowel syndrome compared with the non–congenital heart disease group.



Reference: click to get abstract

Short- and Long-Term Outcomes of Necrotizing Enterocolitis in Infants With Congenital Heart Disease - Pediatrics 2009;123:e901–e906