title: Necrotising enterocolitis in infants with congenital heart disease: the role of enteral feeds.
abstract: OBJECTIVE
  Necrotising enterocolitis is a rare, though catastrophic complication that may occur in term newborns with congenital heart disease. There is considerable controversy regarding the factors that lead to necrotising enterocolitis in this population. We sought to determine the incidence of necrotising enterocolitis among term and near-term newborns with congenital heart disease, focusing on the relationship of enteral feeding to this complication.
  
  
  METHODS
  In this retrospective study, we identified the incidence of necrotising enterocolitis among 1551 newborns admitted to our cardiac intensive care unit between July 1, 2002 and July 1, 2010. In order to understand the impact of enteral feeding upon the development of necrotising enterocolitis, we undertook a nested 2:1 matched case-control analysis to compare feeding patterns in an age- and lesion-matched control population.
  
  
  RESULTS
  Necrotising enterocolitis developed in 45 term or near-term infants (3%). The majority of these cases, 27 (60%), occurred in the post-operative period after the introduction of enteral feeds. This subgroup was used for matched analysis. There were no differences in enteral feeding patterns among the patients who developed necrotising enterocolitis and their matched controls. The overall mortality rate for patients who developed necrotising enterocolitis was 24.4% (11 out of 45).
  
  
  CONCLUSIONS
  Despite numerous advances in the care of infants with congenital heart disease, necrotising enterocolitis remains a significant source of morbidity and mortality. In these infants, there is no clear relationship between enteral feeding patterns and the development of necrotising enterocolitis in the post-operative period. The benefits of graduated feeding advancements to avoid the development of necrotising enterocolitis remain unproven.
authors.affiliation: Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Sibley Heart Center, Emory University School of Medicine, Atlanta, Georgia 30322-1062, United States of America. iannuccig@kidsheart.com
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Iannucci
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D016022:Case-Control Studies; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D047929:Term Birth