Premature infants with heart defects more likely to develop necrotizing enterocolitis

January 30, 2014 – Danny Benjamin, MD, MPH, PhD, and other DCRI researchers examined patient data from more than 98,000 premature infants in the United States.

Premature infants with ventricular and/or atrial septal defects are more likely to develop necrotizing enterocolitis (NEC) compared with premature infants without such defects, according to a new study by DCRI researchers.

The study, by the DCRI’s Jesse Bain, DO; Danny Benjamin, MD, MPH, PhD (pictured); and P. Brian Smith, MD, MPH, MHS; former DCRI fellow Christoph Hornik, MD, MPH; and colleagues from other institutions, appears in the online edition of the Journal of Perinatology.

daniel-benjaminNEC, an infection that causes the destruction of the bowel, is a common and often fatal complication resulting from premature birth. Infants with NEC who survive often suffer from a number of complications, including short bowel syndrome, subsequent intestinal strictures, neurodevelopmental impairment, and growth delay. Earlier research has linked congenital heart defects with an increased risk of developing NEC. These studies, however, did not evaluate ventricular septal defects (VSDs) and atrial septal defects (ASDs) in isolation from other congenital heart defects. In this study, the researchers attempted to determine the frequency of NEC in premature infants with a VSD or ASD independent of other conditions.

Using patient information from an administrative database, the researchers identified a study cohort of 98,523 premature, underweight (<1,500 g) infants treated at 312 neonatal intensive care units across the United States. The database included information on diagnoses, medications, gestational age, birth weight, method of delivery, Apgar score, sex, race, and occurrence of NEC. Diagnosis of septal defects was based on echocardiography results.

After conducting a statistical analysis, the researchers determined that of the original study cohort, 1,904 (1.9 percent) had an ASD, 1,943 (2.0 percent) had a VSD, and 146 (0.1 percent) had both. The incidence of NEC was 6.2 percent in infants without septal defects, 9.3 percent in those with an ASD, 7.8 percent in those with a VSD, and 10.3 percent in those with both an ASD and a VSD. Compared with infants who did not have septal defects, the adjusted odds ratios for developing NEC for each group—ASD alone, VSD alone, and ASD with VSD—were 1.26 (95 percent confidence interval 1.07-1.49), 1.27 (1.07-1.51), and 1.79 (1.03-3.12), respectively.

These findings, the researchers concluded, demonstrated that infants with an ASD and/or a VSD had an increased likelihood of developing NEC as compared with infants without septal defects in the cohort group.