A cluster of necrotizing enterocolitis in term infants undergoing open heart surgery

Background: Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease of unknown cause that predominantly affects premature infants, but it has been reported in term infants with congenital heart disease. Methods: In August and September of 1997, 4 cases of NEC in term infants with congenital heart disease were identified among 24 infants undergoing cardiac surgical procedures at our institution. Because nosocomial NEC had not previously been identified among infants in our pediatric intensive care unit, a case-control study was conducted to identify risk factors for NEC. All infants less than 4 months old undergoing cardiac surgery without development of NEC during the epidemic period were selected as controls. Results: The only significant risk factor associated with case-infants was a higher mean temperature gradient (rectal/toe) during the immediate 12-hour postoperative period (4.0°C vs 2.0°C, P< .01). Urine output was higher in control-infants in this postoperative period, although not statistically significant (11.9 mL/h vs 6.1 mL/h, P = .15). Conclusion: Although an infectious etiology cannot be ruled out, the cases of NEC in infants with congenital heart disease after cardiac procedures may have resulted from mesenteric ischemia associated with a low perfusion state in the perioperative period.