The following is a summary of “Management of Hematochezia in Infants with Congenital Heart Disease Admitted to the Acute Care Cardiology Unit: A Multi-Center Retrospective Pilot Study,” published in the February 2024 issue of Pediatrics by Pradhan et al.
This retrospective multicenter study aims to evaluate the prevalence and diagnostic approach of benign hematochezia (BH) versus necrotizing enterocolitis (NEC) in infants under six months with congenital heart disease (CHD) admitted to the Acute Care Cardiology Unit (ACCU).
A comprehensive retrospective review was conducted across three high-volume tertiary care centers from February 2019 to January 2021. Patient characteristics and evaluation of all hematochezia events in CHD infants <6 months admitted to ACCU were analyzed. NEC diagnosis was based on Bell’s staging criteria, and patients with gastrointestinal disorders were excluded from the study.
Among 121 patients, 180 hematochezia events were recorded, with 42 patients experiencing multiple episodes. Notably, 61% of patients presented with BH, while 23% were diagnosed with NEC. No surgical interventions or NEC-related deaths were reported. Younger age (34 vs. 56 days, p<0.01) and lower weight (3.7 vs. 4kg, p<0.01) were significantly associated with NEC. Single ventricle physiology was a significant risk factor for NEC development. Initial bloodwork and diagnostic imaging were inconclusive, with no significant differences in white blood cell count or C-reactive protein between NEC and BH cases. Blood cultures yielded negative results.
The findings highlight that most CHD infants presenting with hematochezia have BH rather than NEC, although those with single ventricle physiology remain at heightened risk. Infants younger than 45 days are particularly susceptible to NEC. Despite routine bloodwork, its utility in distinguishing cardiac NEC was limited. Prospective studies are warranted to develop tailored treatment algorithms to prevent unnecessary interventions in this vulnerable population.
Source: sciencedirect.com/science/article/abs/pii/S0022347624000957
