G253(P) The risk of developing necrotising enterocolitis in infants with congenital heart disease undergoing invasive cardiac procedures. (12th March 2018)

• Record Type: Journal Article
• Authors: Nellihela, LP; Wang, H; Mutalib, M; Hort, A; Upadhyaya, M
• Is Part Of: Archives of disease in childhood. Volume 103(2018)Supplement 1
• Page Start: A104
• Page End: A104
• Publication Date: 2018-03-12
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2018-rcpch.246
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: Prematurity is the most significant risk factor for developing necrotising enterocolitis (NEC). However, congenital heart disease (CHD) is also a well-recognised risk factor. Our aim was to identify the incidence of NEC in term children undergoing invasive cardiac procedures. Methods: This was 5 year (January 2010 to December 2015) retrospective review of all infants admitted with CHD. Data was collected on demographics, NEC (incidence, clinical management and mortality) and invasive cardiac procedure (ICaP) defined as either open-heart surgery or cardiac catheterisation. Incidence of NEC was compared in the two groups (ICaP and non-ICaP). Institutional ethical approval was given. p value<0.05 was significant. Result: 5103 infants with CHD were identified. 31.5% (n=1608) patients had an ICaP.Overall 128/5103 (2.5%) of patients developed NEC: 102/1608 in ICaP group; 26/3495 in non ICaP group, p<0.001.Median gestational age was 37 weeks (range 29 to 42). Median age at presentation was 6 weeks (range 0.4 to 104).The most common cardiac diagnoses were, hypoplastic left heart 45 (33.5%), ventricular septal defect (VSD) 16 (12%), isolated PDA 10 (7.4%).60 had multiple cardiac procedures and 42 had a single cardiac procedure, p>0.5. 52% (n=66) of patients had pneumatosis and 7% (n=9) had pneumoperitoneum. 79% (n=101) of patients were managed conservatively. 21% (27/128) required surgery: 18/27 (67%) in ICaP and 9/27 in non-ICaP group, p>0.5. Multiple cardiac procedures significantly increased the risk of needing a laparotomy, p=0.01. Intraoperatively, 44% (n=12) had a bowel perforation and rest had significant NEC. 41% (n=11) had primary resection and anastomosis; 16/27 had a stoma.Overall mortality was 7%: 5 patients died pre-operatively and 4 patients died post-operatively, however an ICaP was not a significant factor for mortality in NEC (p>0.5). Conclusion: Invasive cardiac procedure is a significant factor in developing NEC in term infants. A single ICaP did not increase the risk for either needing laparotomy or mortality, but multiple cardiac procedures did further increased the risk for laparotomy in children with NEC. This information could be used for counselling and risk stratifying cardiac patients.