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

Background: Necrotizing enterocolitis (NEC) is a serious gastrointestinal d isease of unknown cause that predominantly affects premature infants, but i t has been reported in term infants with congenital heart disease Methods: In August and September of 1997, 4 cases of NEC in term infants wi th congenital heart disease were identified among 24 infants undergoing car diac surgical procedures at our institution. Because nosocomial NEC had not previously been identified among infants in our pediatric intensive care u nit, a case-control study was conducted to identify risk factors for NEC. A ll infants less than 4 months old undergoing cardiac surgery without develo pment 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-hou r postoperative period (4.0 degrees C vs 2.0 degrees C, P < .01). Urine out put was higher in control-infants in this postoperative period, although no r 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 ma y have resulted from mesenteric ischemia associated with a low perfusion st ate in the perioperative period.