Abstract
Infants with congenital heart disease are known to have higher rates of necrotizing enterocolitis (NEC) which is associated with poorer outcomes. Although the etiology is recognized as distinct from the premature neonatal population, there is not a universal consensus regarding etiology or specific risk factors. In this retrospective single-institution case–control study, we assessed whether aortic pulsatility index (PI) as detected via ultrasound might be associated with NEC in neonates undergoing cardiac surgical repair within the first month of life. The study identified 30 participants who developed NEC and 50 matched controls. Baseline demographic and surgical characteristics were similar between groups. Patients who developed NEC had higher mortality (26% vs 4%, p < 0.01). Standard PI and the modified pulsatility values were calculated manually and underwent logistic regression. The median log PI of the NEC cohort was higher compared to the lowest control PI (0.68 vs 0.48, p = 0.03); the median log PI of the NEC cohort was significantly lower than the highest PI of the control cohort (0.61 vs 0.98, p = 0.05). The modified pulsatility index demonstrated similar trends with the median log MODPI of the NEC cohort being significantly greater than that of the control cohort (3.9 vs. 3.1, p = 0.01). Infants with congenital heart disease who develop NEC have a higher PI and MODPI when compared to the lowest control PI. This suggests that infants with a higher baseline PI may be at increased risk for developing NEC.
Similar content being viewed by others
References
Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364(3):255–264. https://doi.org/10.1056/NEJMra1005408
Bisquera JA, Cooper TR, Berseth CL (2002) Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 109(3):423–428
McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW, Wernovsky G (2000) Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106(5):1080–1087
Carlo WF, Kimball TR, Michelfelder EC, Border WL (2007) Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease. Pediatrics 119(2):330–335
Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE (2008) Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 82(7–8):341–347
Miller TA, Minich LL, Lambert LM, Joss-Moore L, Puchalski MD (2014) Abnormal abdominal aorta hemodynamics are associated with necrotizing enterocolitis in infants with hypoplastic left heart syndrome. Pediatr Cardiol 35(4):616–621
Kessler U, Hau EM, Kordasz M, Haefeli S, Tsai C, Klimek P, Berger S (2018) Congenital heart disease increases mortality in neonates with necrotizing enterocolitis. Front Pediatr 6:312
Bilardo CM, Wolf H, Stigter RH, Ville Y, Baez E, Visser GHA, Hecher K (2004) Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction. Ultrasound Obstet Gynecol 23(2):119–125
Ackerstaff RGA, Moons KGM, Van de Vlasakker CJW, Moll FL, Vermeulen FEE, Algra A, Spencer MP (2000) Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke 31(8):1817–1823
Chen CY, Wu YC, Yen MS, Hung JH, Yuan CC, Chao KC (2007) The power Doppler velocity index, pulsatility index, and resistive index can assist in making a differential diagnosis of primary ovarian carcinoma and Krukenberg tumors: a preliminary study. J Ultrasound Med 26(7):921–926
Gordon PV, Swanson JR, Attridge JT, Clark R (2007) Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell’s criteria? J Perinatol 27(11):661–671
Author information
Authors and Affiliations
Contributions
MP, as the primary author of this manuscript consciously assure that the following is fulfilled: (1) This material is the authors’ own original work, which has not been previously published elsewhere. (2) The paper is not currently being considered for publication elsewhere. (3) The paper reflects the authors’ own research and analysis in a truthful and complete manner. (4) The paper properly credits the meaningful contributions of co-authors and co-researchers. (5) The results are appropriately placed in the context of prior and existing research. (6) All sources used are properly disclosed with correct citations. (7) All authors have been personally and actively involved in substantial work leading to the paper and will take public responsibility for its content.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Informed Consent
This study was conducted without any potential conflict of interest. The study was conducted as a retrospective review of patient data from our institution without active deviation or intervention from standard of care without need for informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pham, M., Dean, P., McCulloch, M. et al. Association Between Pulsatility Index and the Development of Necrotizing Enterocolitis in Infants with Congenital Heart Disease. Pediatr Cardiol 43, 1156–1162 (2022). https://doi.org/10.1007/s00246-022-02839-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-022-02839-7