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Feeding Practices in Infants with Hematochezia and Necrotizing Enterocolitis on Acute Care Cardiology Units

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Abstract

Infants with congenital heart disease (CHD) are at risk for developing both benign hematochezia and necrotizing enterocolitis (NEC). Despite these risks there are very few studies that investigate modifiable risk factors such as feeding practices. It remains unclear what feeding practices should be avoided due to higher incidence of CHD-NEC. We aim to assess the feeding practices across three high volume tertiary centers to establish a relationship between various feeding practices and development of NEC. A multicenter retrospective review of feeding practices at the time of documented hematochezia event that occurred between 1/2019 and 1/2021 in infants with CHD who were less than 6 months of age. NEC was defined as Bells Stage 2 or greater. Age, weight, ventricular morphology, primary diagnoses, feeding route, feed change, and formula type were evaluated. 176 hematochezia events occurred in 121 patients, 72% of these events were considered benign hematochezia with the remaining 28% being true NEC. Single ventricle (SV) physiology (p < 0.05), younger age, < 45 days of life, (p < 0.001), and feeding route were statistically associated with true NEC (p < 0.01). Formula type and recent change in feed administration were not associated with NEC. The caloric density of feeds at the time of hematochezia was nearing significance. The majority of hematochezia events are benign in nature, however, there should be heightened awareness in patients who are SV, younger in age, and those who are post-pylorically fed. There may be some risk in using higher caloric density feeds (> 24 kcal/oz), however, additional research is needed to fully establish this relationship.

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Acknowledgements

Amy Schiller on behalf of the Pediatric Acute Care Cardiology Collaborative (PAC3)

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No funding was received to support the preparation of this manuscript.

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Authors and Affiliations

  1. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kelsey Palm & Dustin Nash

  2. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Amiee Trauth

  3. Cincinnati Children’s Hospital Medical Center, Heart Institute Research Core, Cincinnati, OH, USA

    Zhiqian Gao

  4. Temerty School of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Sarah Pradhan

  5. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Sarah Pradhan & Elisa Marcuccio

  6. The University of Pennsylvania Perelman School of Medicine and the Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan Schachtner

  7. Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA

    Courtney Strohacker

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KP wrote the main manuscript text. ZG prepared graphics. All Authors reviewed the manuscript.

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Correspondence to Kelsey Palm.

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Palm, K., Trauth, A., Gao, Z. et al. Feeding Practices in Infants with Hematochezia and Necrotizing Enterocolitis on Acute Care Cardiology Units. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03406-y

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