Abstract：
OBJECTIVE: To assess the evaluation and prevalence of benign hematochezia (BH) vs necrotizing enterocolitis (NEC) in infants with congenital heart disease (CHD) <6 months old admitted to the acute care cardiology unit.
METHODS: This was a multicenter retrospective review of patient characteristics and evaluation of all hematochezia events in patients with CHD <6 months admitted to acute care cardiology unit at 3 high-volume tertiary care centers from February 2019 to January 2021. NEC was defined by the Bell staging criteria. Patients with gastrointestinal disorders were excluded.
RESULTS: In total, 180 hematochezia events occurred in 121 patients; 42 patients had more than 1 event. In total, 61% of affected patients had single-ventricle physiology (38% hypoplastic left heart syndrome). Median age and weight at hematochezia were 38 days (IQR 24, 79) and 3.7 kg (IQR 3.2, 4.4). In total, 77% of hematochezia events were BH, and 23% were NEC. There were no surgical interventions for NEC or deaths from NEC. Those with NEC were significantly younger (34 vs 56 days, P < .01) and smaller (3.7 vs 4 kg, P < .01). Single-ventricle physiology was significantly associated with NEC. Initial bloodwork and diagnostic imaging at each center were assessed. There was no significant difference in white blood cell count or C-reactive protein in those with NEC compared with BH. Blood culture results were all negative.
CONCLUSIONS: The majority of infants with CHD with hematochezia have BH over NEC, although single-ventricle and surgical patients remain at greater risk. Infants <45 days are more vulnerable for developing NEC. Bloodwork was noncontributory in the identification of cardiac NEC. Expansion to a prospective study to develop a treatment algorithm is important to avoid overtreatment.
METHODS: This was a multicenter retrospective review of patient characteristics and evaluation of all hematochezia events in patients with CHD <6 months admitted to acute care cardiology unit at 3 high-volume tertiary care centers from February 2019 to January 2021. NEC was defined by the Bell staging criteria. Patients with gastrointestinal disorders were excluded.
RESULTS: In total, 180 hematochezia events occurred in 121 patients; 42 patients had more than 1 event. In total, 61% of affected patients had single-ventricle physiology (38% hypoplastic left heart syndrome). Median age and weight at hematochezia were 38 days (IQR 24, 79) and 3.7 kg (IQR 3.2, 4.4). In total, 77% of hematochezia events were BH, and 23% were NEC. There were no surgical interventions for NEC or deaths from NEC. Those with NEC were significantly younger (34 vs 56 days, P < .01) and smaller (3.7 vs 4 kg, P < .01). Single-ventricle physiology was significantly associated with NEC. Initial bloodwork and diagnostic imaging at each center were assessed. There was no significant difference in white blood cell count or C-reactive protein in those with NEC compared with BH. Blood culture results were all negative.
CONCLUSIONS: The majority of infants with CHD with hematochezia have BH over NEC, although single-ventricle and surgical patients remain at greater risk. Infants <45 days are more vulnerable for developing NEC. Bloodwork was noncontributory in the identification of cardiac NEC. Expansion to a prospective study to develop a treatment algorithm is important to avoid overtreatment.
摘要：
目的：评估心内科急性监护病房6月龄以下先天性心脏病（CHD）婴儿良性便血（BH）与坏死性小肠结肠炎（NEC）的评估和患病率。
方法：这是一项多中心回顾性研究，研究了2019年2月至2021年1月在3个大批量三级护理中心接受急性护理心脏科治疗的冠心病<6个月患者的患者特征和所有便血事件的评估。NEC由贝尔分期标准定义。排除患有胃肠道疾病的患者。
结果：总计，121例患者发生便血事件180例；42例患者发生1例以上事件。总的来说,61％的受影响患者具有单心室生理机能（38％的左心发育不良综合征）。便血时的中位年龄和体重分别为38天（IQR24、79）和3.7kg（IQR3.2、4.4）。总的来说,77%的便血事件是BH，23%是NEC。没有针对NEC或NEC死亡的手术干预。NEC患者明显年轻（34天vs56天，P<.01）和更小（3.7比4公斤，P<.01)。单心室生理与NEC显著相关。评估每个中心的初始血液和诊断成像。与BH相比，NEC患者的白细胞计数或C反应蛋白没有显着差异。血培养结果均为阴性。
结论：大多数患有便血的CHD婴儿的BH高于NEC，尽管单心室和手术患者仍然面临更大的风险。<45天的婴儿更容易发生NEC。血液工作对心脏NEC的鉴定没有贡献。扩展到前瞻性研究以开发治疗算法对于避免过度治疗很重要。
方法：这是一项多中心回顾性研究，研究了2019年2月至2021年1月在3个大批量三级护理中心接受急性护理心脏科治疗的冠心病<6个月患者的患者特征和所有便血事件的评估。NEC由贝尔分期标准定义。排除患有胃肠道疾病的患者。
结果：总计，121例患者发生便血事件180例；42例患者发生1例以上事件。总的来说,61％的受影响患者具有单心室生理机能（38％的左心发育不良综合征）。便血时的中位年龄和体重分别为38天（IQR24、79）和3.7kg（IQR3.2、4.4）。总的来说,77%的便血事件是BH，23%是NEC。没有针对NEC或NEC死亡的手术干预。NEC患者明显年轻（34天vs56天，P<.01）和更小（3.7比4公斤，P<.01)。单心室生理与NEC显著相关。评估每个中心的初始血液和诊断成像。与BH相比，NEC患者的白细胞计数或C反应蛋白没有显着差异。血培养结果均为阴性。
结论：大多数患有便血的CHD婴儿的BH高于NEC，尽管单心室和手术患者仍然面临更大的风险。<45天的婴儿更容易发生NEC。血液工作对心脏NEC的鉴定没有贡献。扩展到前瞻性研究以开发治疗算法对于避免过度治疗很重要。
