BACKGROUND: Infants with congenital heart disease(CHD) are at risk for necrotizing enterocolitis (NEC). We performed a case-control study of infants admitted to the cardiac critical care unit during a five year period in order to determine the incidence, risk factors and outcomes for NEC in patients with congenital heart disease.

METHODS: NEC cases were identified by ICD-10 codes and matched with random CHD controls. Cases and controls were compared for NEC risk factors; factors associated with NEC were tested in a multivariate logistic regression model.

RESULTS: Sixty-six NEC cases occurred in 1,185 consecutive admissions with an incidence of 5.7 [4.3 - 7.0]%; 30 (45%) developed NEC postoperatively. Lower gestational age at birth, OR = 1.2 [1.1 - 1.4], p = 0.02; lower birth weight, OR = 1.1 [1.05 - 1.2], p = 0.006; non-singleton pregnancy, OR = 3.3 [1.1 - 10.8], p = 0.05; acidosis, OR = 3.1 [1.4 - 6.7), p = 0.004 and hypotension, OR = 1.1 [1.05 - 1.2], p = 0.002 were significantly associated with the subsequent development of NEC. Median intensive care unit length of stay was significantly higher in the NEC group versus controls (10 vs 5 days, p = 0.003). Death occurred in 11 of 66 (17%) patients with NEC compared with 6 of 66 controls (9.1%), OR = 2.0 [0.7 - 5.8], p = 0.09.

CONCLUSIONS: NEC is a frequent complication of CHD with significant implications for morbidity and mortality. Prevention of acidosis and hypotension may modify these risks.