Managing the Congenital Heart Disease Patient With Suspected or Confirmed Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal illness that affects high-risk populations such as those with congenital heart disease (CHD). A diagnosis of NEC, before and after cardiac surgery, can have serious and irreversible consequences. Here, we review perioperative management strategies that could potentially reduce the incidence of NEC in CHD. The literature is rich in investigative work regarding NEC in preterm infants; however, these data are extrapolated to infants with CHD. The pathogenesis of NEC in CHD is thought to be multifactorial, with splanchnic hypoperfusion being a major contributor. The data suggest that early enteral feeding with human milk, the use of probiotics, thoughtful use of red blood cell transfusions, and near-infrared spectroscopy may be useful tools in the prevention of NEC. NEC is an illness with the potential for high morbidity and mortality, particularly in CHD. Therefore, prevention of NEC should be the clinician’s focus when caring for these infants. Well-designed studies and evidence-based guidelines to standardize care in these infants are much needed to improve the outcome of NEC.