Abstract 4145384: Incidence of Necrotizing Enterocolitis (NEC) in Infants with Congenital Heart Disease on the Acute Care Cardiology Unit (ACCU): A Report from the Pediatric Acute Care Cardiology Collaborative (PAC3)

Introduction: Necrotizing enterocolitis (NEC) is a life-threatening condition of compromised gastrointestinal mucosa with risk of progression to ischemia, necrosis and perforation. The incidence and outcomes of NEC in infants with congenital heart disease (CHD) are incompletely understood. Hypothesis: Patients who develop NEC in the acute care cardiology unit (ACCU) are likely to have different patient characteristics and worse clinical outcomes than those who do not develop NEC. Aims: Describe differences in baseline characteristics and clinical outcomes in infants < 6 months of age with CHD in the ACCU who suffered NEC compared to those who did not. Methods: Data were analyzed from the Pediatric Acute Care Cardiology Collaborative (PAC 3 ) database. All patients < 6 months were included. Patients who had NEC (Bell’s stage ≥2) on the ACCU were compared to those who did not. Results: In 29041 patient encounters from 16770 unique patients across 33 centers, the incidence of NEC was 1.5%. Patients with NEC were more likely to have extracardiac abnormalities, antenatal diagnosis and have undergone procedural intervention (Table 1). Patients who developed NEC had longer lengths of stay and higher rates of mortality, CICU transfer and readmission (Table 2). In addition, patients who developed NEC had lower rates of oral feeding at encounter end. Of 14823 patients in their post-surgical encounter, those who developed NEC were significantly more likely to have undergone a more complex index procedure and to be younger, lower weight and on prostaglandin at the time of surgery. Patients who developed NEC were more likely to be on anticoagulation, ACE-inhibitors, anti-reflux medications, milrinone, diuretics and anticonvulsants. Conclusion: In this original multicenter analysis, patients who developed NEC on the ACCU had different characteristics and significantly worse clinical outcomes. Further study is warranted to identify risk factors for NEC in this vulnerable population.