Abstract 9327: Risk Factors for Adverse Outcomes in Term Infants With Congenital Heart Disease and Necrotizing Enterocolitis

Abstract

Introduction: Infants with congenital heart disease (CHD) are at increased risk of developing necrotizing enterocolitis (NEC), with mortality rates up to 57%. The aim of this study was to investigate pre-NEC factors associated with adverse outcomes in term infants with CHD-NEC. Methods: We performed a 20-year (2000-2020) single-institution retrospective cohort study in term infants (>37 weeks) <6 months of age admitted to the Boston Children’s Hospital Cardiac Intensive Care Unit with CHD-NEC (Bell’s stage > 2). The primary outcome was a composite of in-hospital mortality and post-NEC morbidity (extracorporeal life support or surgical NEC). Predictors included baseline admission patient characteristics, cardiac diagnosis and intervention, feeding regimen, and severity of illness, as measured with the pediatric sequential organ failure assessment (pSOFA) score. Results: We identified 82 patients with CHD-NEC from 3933 admissions (prevalence, 2.1%), including 54 (66%) duct dependent and 55 (67%) with NEC post cardiac surgery. Twenty-seven (33%) met the primary outcome, (in-hospital mortality in 14 (17%) with 9 (64%) attributed to NEC). In univariate analysis, pre-NEC factors significantly associated with the primary outcome included female sex, fetal growth restriction, systolic dysfunction, older age and weight at NEC ( Table ). Feeding regimen (formula, caloric density), genetic conditions, APGARs, race, cardiac lesion, outflow tract z-score or STAT category had no impact on outcome. In multivariable analysis, peri-NEC pSOFA, lower weight and older age at NEC diagnosis remained significantly associated with the primary outcome (Table) . Conclusions: Radiologically-proven NEC occurred in 2% of term infants with CHD, with death and adverse post-NEC outcomes in more than one-third. Lower weight and older age at diagnosis were associated with adverse outcomes informing risk-triage and prognostic counseling for families.