Pathophysiology of neonatal necrotizing enterocolitis in term infants complicated with congenital heart disease: A single center, retrospective study with 7 patients

Abstract

 All the seven cases of neonatal necrotizing enterocolitis（NEC）in full-term infants treated at our hospital had congenital heart disease（CHD）, which we defined as CHD-NEC. We retrospectively examined the clinical backgrounds, pathogenesis, patterns of onset, and outcomes of CHD-NEC.

 Single ventricle circulation was detected in five cases（71%）. In all seven patients, mesenteric hypoperfusion prior to onset was suspected; high pulmonary blood flow was implicated in five; and in two, onset followed cardiac arrest and multiorgan failure. Surgical interventions for NEC were performed in five cases（71%）. Necrotizing intestinal lesions were beyond the distal end of the ileum in all cases, colonic lesions were detected in six cases（86％）. The mortality rate was 57%, but all deaths occurred in the long-term postoperative period. They had few risk factors typically associated with preterm NEC（PT-NEC）.

 In contrast to PT-NEC associated primarily with intestinal immaturity, CHD-NEC was caused by mainly decreasing intestinal blood flow. Predominance of colon in necrotizing lesion was particularly characteristic in CHD-NEC. We suggest that CHD-NEC should be regarded as a distinct pathophysiological mechanism to PT-NEC, and it is essential to optimize targeted prevention and management strategies for CHD-NEC.