Breast Milk and Necrotizing Enterocolitis in Congenital Heart Disease: A Case-Control Study

Area of Science:

• Neonatalogy
• Pediatric Cardiology
• Gastroenterology

Background:

• Necrotizing enterocolitis (NEC) is a serious complication in infants with congenital heart disease (CHD).
• Breast milk is known to reduce NEC incidence in preterm infants, but its protective role in CHD infants is unclear.

Purpose of the Study:

• To determine if breast milk intake is protective against NEC in infants with CHD.
• To identify risk factors for NEC in infants with CHD.

Main Methods:

• Retrospective case-control study of infants (≥33 weeks gestational age) with CHD who underwent cardiac surgery.
• Cases defined as modified Bell's stage ≥II NEC; controls matched by birth date, gestational age, and feeding initiation.
• Multivariable analysis used to identify independent risk factors.

Main Results:

• 18 NEC cases and 84 controls identified among 926 infants with CHD.
• Higher breast milk intake in controls was not statistically significant.
• Single ventricle (SV) physiology was an independent risk factor for NEC; NEC cases with SV had later surgery (median 9 days) vs. controls (median 5 days).

Conclusions:

• The study is inconclusive on feeding composition's role in NEC risk for CHD infants, but a trend suggests breast milk may be protective.
• Infants with SV physiology face a high risk of NEC.
• Earlier Stage I palliation may be a modifiable risk factor for NEC in this population.