Necrotizing Enterocolitis in Term Neonates with Critical Congenital Heart Disease: Associated Risk Factors and Clinical Outcomes
Journal of Cardiovascular Development and Disease, cilt.13, sa.7, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 13 Sayı: 7
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcdd13070329
- Dergi Adı: Journal of Cardiovascular Development and Disease
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals, Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: congenital heart disease, necrotizing enterocolitis, term neonate, critical CHD, risk factors
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication that may develop in term neonates with critical congenital heart disease (CHD), despite the absence of prematurity. We aimed to evaluate the incidence of NEC and identify clinical factors associated with NEC development in term neonates with critical CHD. Methods: This retrospective cohort study included term neonates (≥37 weeks’ gestation) with critical CHD admitted to a tertiary pediatric cardiac intensive care unit between 1 January 2022, and 1 January 2026. NEC was defined as stage IIA or higher according to modified Bell’s criteria. Demographic, clinical, perioperative, and nutritional variables were analyzed. Multivariable logistic regression analysis was performed to identify factors independently associated with NEC development. Results: A total of 780 term neonates with critical CHD were included. NEC developed in 18 infants (2.3%). The median age at NEC diagnosis was 7 days (IQR 5–10), and four patients (22%) required surgical intervention. Seven NEC cases occurred preoperatively, whereas 11 developed after cardiac surgery; among postoperative cases, 64% occurred within the first 72 h after surgery. Birth weight < 2.5 kg (aOR 4.1, 95% CI 1.2–13.4; p = 0.021), gestational age < 38 weeks (aOR 3.9, 95% CI 1.3–12.0; p = 0.018), functional single-ventricle physiology (aOR 5.8, 95% CI 1.6–20.7; p = 0.007), and mechanical ventilation dependency (aOR 5.1, 95% CI 1.7–15.2; p = 0.004) were independently associated with NEC development. Mortality was significantly higher among infants with NEC compared with those without NEC (50% vs. 7.7%, p < 0.001). Conclusions: NEC remains an important complication associated with substantial mortality in term neonates with critical CHD, despite its relatively low incidence. Early-term birth, low birth weight, functional single-ventricle physiology, and dependence on mechanical ventilation were independently associated with increased NEC risk in this vulnerable population.