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Breast Milk and Necrotizing Enterocolitis in Congenital Heart Disease: A Case-Control Study
Margaret R Christian1, David Bateman1, Marianne Garland1
1Division of Neonatology, Department of Pediatrics, Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA.
Insights
This study investigated necrotizing enterocolitis (NEC) in infants with congenital heart disease (CHD). While not conclusive, findings suggest breast milk may be protective, and single ventricle physiology is a risk factor for NEC.
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.
Abstract:
Background: Necrotizing enterocolitis (NEC) is a complication that can affect infants with congenital heart disease (CHD). The objective of this study is to determine whether breast milk, which is associated with decreased incidence of NEC in preterm infants, is protective in infants with CHD. Methods: Retrospective case-control study of infants ≥ 33 weeks gestational age with CHD who underwent cardiac surgery during their admission to the Infant Cardiac Unit from 2008 to 2017. Cases were defined as infants with modified Bell's stage ≥ II NEC. Controls were matched by date of birth, gestational age, and pre- or postcardiac surgery feed initiation. Results: A total of 926 infants with gestational age ≥ 33 weeks and CHD were admitted; 18 cases of NEC were identified and compared with 84 controls. Breast milk intake was higher in controls, but this difference was not statistically significant. Single ventricle (SV) physiology was identified as an independent risk factor for NEC by multivariable analysis. Analysis of infants with SV physiology demonstrated that median age at time of surgery was 9 days (interquartile range [IQR], 7-12) in NEC cases and 5 days (IQR, 4-9) in controls (P = .02). Conclusions: While this study is inconclusive with regard to feeding composition and risk of NEC in infants with CHD, the trend toward greater intake of breast milk in the control group suggests that breast milk may be protective for these infants. Infants with SV physiology are at high risk for NEC. Earlier time to stage I palliation may be a modifiable risk factor for NEC.
