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Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects

Journal of Perinatology volume 34, pages 319–321 (2014)Cite this article

Subjects

Abstract

Objective:

Necrotizing enterocolitis (NEC) is associated with a significant morbidity and mortality in premature infants. We sought to identify the frequency of NEC in very-low-birth-weight infants with isolated ventricular septal defects (VSDs) or atrial septal defects (ASDs) using a large multicenter database.

Study design:

We identified a cohort of infants with birth weight <1500 g cared for in 312 neonatal intensive care units (NICUs) managed by the Pediatrix Medical Group between 1997 and 2010. We examined the association between the presence of an ASD or a VSD with development of NEC using logistic regression to control for small-for-gestational age status, antenatal steroid use, antenatal antibiotic use, gestational age, sex, race, Apgar score at 5 min and method of delivery.

Result:

Of the 98 523 infants who met inclusion criteria, 1904 (1.9%) had an ASD, 1943 (2.0%) had a VSD and 146 (0.1%) had both. The incidence of NEC was 6.2% in infants without septal defects, 9.3% in those with an ASD, 7.8% in those with a VSD, and 10.3% in infants with both an ASD and a VSD. Compared with infants without septal defects, the adjusted odds ratios for developing NEC for each group—ASD alone, VSD alone and ASD with VSD—were 1.26 (95% confidence interval 1.07 to 1.49), 1.27 (1.07 to 1.51) and 1.79 (1.03 to 3.12), respectively.

Conclusion:

The presence of an ASD or a VSD was associated with NEC in this cohort of premature infants.

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References

  1. Neu J, Walker WA . Necrotizing enterocolitis. N Engl J Med 2011; 364: 255–264.

    Article  CAS  Google Scholar 

  2. Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH . Necrotizing enterocolitis among neonates in the United States. J Perinatol 2003; 23: 278–285.

    Article  Google Scholar 

  3. Luig M, Lui K . Epidemiology of necrotizing enterocoliti—Part I: Changing regional trends in extremely preterm infants over 14 years. J Paediatr Child Health 2005; 41: 169–173.

    Article  Google Scholar 

  4. Llanos AR, Moss ME, Pinzon MC, Dye T, Sinkin RA, Kendig JW . Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol 2002; 16: 342–349.

    Article  Google Scholar 

  5. Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB . Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol 2006; 20: 498–506.

    Article  Google Scholar 

  6. Lin PW, Stoll BJ . Necrotising enterocolitis. Lancet 2006; 368: 1271–1283.

    Article  Google Scholar 

  7. Henry MC, Moss RL . Neonatal necrotizing enterocolitis. Semin Pediatr Surg 2008; 17: 98–109.

    Article  Google Scholar 

  8. Neu J, Mihatsch W . Recent developments in necrotizing enterocolitis. J Parenter Enteral Nutr 2012; 36 (1 Suppl): 30S–35S.

    Article  Google Scholar 

  9. McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.

    Article  CAS  Google Scholar 

  10. Bolisetty S, Lui K, Oei J, Wojtulewicz J . A regional study of underlying congenital diseases in term neonates with necrotizing enterocolitis. Acta Paediatr 2000; 89: 1226–1230.

    Article  CAS  Google Scholar 

  11. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.

    Article  Google Scholar 

  12. Mukherjee D, Zhang Y, Chang DC, Vricella LA, Brenner JI, Abdullah F . Outcomes analysis of necrotizing enterocolitis within 11 958 neonates undergoing cardiac surgical procedures. Arch Surg 2010; 145: 389–392.

    Article  Google Scholar 

  13. Cheng W, Leung MP, Tam PK . Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease. Pediatr Surg Int 1999; 15: 492–495.

    Article  CAS  Google Scholar 

  14. Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE . Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82 (7-8): 341–347.

    Article  CAS  Google Scholar 

  15. Carlo WF, Kimball TR, Michelfelder EC, Border WL . Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease. Pediatrics 2007; 119: 330–335.

    Article  Google Scholar 

  16. Murdoch EM, Sinha AK, Shanmugalingam ST, Smith GC, Kempley ST . Doppler flow velocimetry in the superior mesenteric artery on the first day of life in preterm infants and the risk of neonatal necrotizing enterocolitis. Pediatrics 2006; 118: 1999–2003.

    Article  Google Scholar 

  17. Hoffman JI, Kaplan S . The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.

    Article  Google Scholar 

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Authors and Affiliations

  1. Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA

    J Bain, D K Benjamin Jr, C P Hornik & P B Smith

  2. Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA

    J Bain, D K Benjamin Jr, C P Hornik & P B Smith

  3. Clemson University, Clemson, SC, USA

    D K Benjamin

  4. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    R Clark

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  1. J Bain
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Correspondence to P B Smith.

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Competing interests

Dr Benjamin receives support from the United States government for his work in pediatric and neonatal clinical pharmacology (1R01HD057956-05, 1K24HD058735-05 and NICHD contract HHSN275201000003I) and the non-profit organization Thrasher Research Fund for his work in neonatal candidiasis (www.thrasherresearch.org); he also receives research support from industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp). Dr Smith receives salary support for research from the National Institutes of Health and the US Department of Health and Human Services (NICHD 1K23HD060040-01, DHHS-1R18AE000028-01 and HHSN267200700051C); he also receives research support from industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp). The other authors declare no conflict of interest.

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Bain, J., Benjamin, D., Hornik, C. et al. Risk of necrotizing enterocolitis in very-low-birth-weight infants with isolated atrial and ventricular septal defects. J Perinatol 34, 319–321 (2014). https://doi.org/10.1038/jp.2013.174

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