W Cheng, PKH Tam, MP Leung

Introduction: Operation is indicated when perforation of gut has occurred in necrotizing enterocolitis (NEC). In this study, management of NEC is reassessed in neonates born with symotomatic congenital heart disease.

Methods: Records of patients admitted into Queen Mary Hospital and Grantham Hospital, Hong Kong between Jan. 1981 and May 1997 during the neonatal period with symptomatic congenital heart disease and subsequently developed NEC were reviewed. The diagnosis and the staging were based on modified Bell's criteria.

Results: Of 780 neonates with congenital heart disease admitted during the' period, 24 patients developed NEC (3%). The average Apgar scores at one and five minutes were 7.6 and 8.7 respectively. The mean gestational age was 37.6 weeks and the mean birth weight was 2.45 kg. The mean age at which NEC developed was 14 days. Seven of them had hypotensive episodes and 6 had renal failure prior to NEC development. Ten had previous cardiac catheterization or operation. The most common clinical presentation was abdominal distension (75%) and per rectal bleeding (38%). Acidosis was present in 6 patients (25%) and disseminated intravascular coagulopathy in three patients (12.5%). The overall mortality was 62.5%.

Of the proven NEC cases without perforation, i.e. stages II and IIIA, surgical management resulted in good survival results (Chi-square, p=0.06). (Fig 2).

Conclusions: Neonates with symptomatic congenital heart disease and developed NEC are more mature babies. The mortality is high and a modified management approach is required. Surgical intervention may be indicated in proven cases of NEC even without gut perforation.