Management of Hematochezia in Infants with Congenital Heart Disease Admitted to the Acute Care Cardiology Unit: A Multi-Center Retrospective Pilot Study

Abstract

Objective

To assess the evaluation and prevalence of benign hematochezia (BH) versus necrotizing enterocolitis (NEC) in infants with congenital heart disease (CHD) <6 months old admitted to the Acute Care Cardiology Unit (ACCU).

Study design

A multicenter retrospective review of patient characteristics and evaluation of all hematochezia events in patients with CHD <6 months admitted to ACCU at three high-volume tertiary care centers from February 2019 to January 2021. NEC was defined by Bell's staging criteria. Patients with gastrointestinal disorders were excluded.

Results

180 hematochezia events occurred in 121 patients; 42 patients had more than one event. 61% of affected patients had single ventricle physiology (38% hypoplastic left heart syndrome). Median age and weight at hematochezia was 38 days [IQR 24, 79] and 3.7kg [IQR 3.2, 4.4]. 77% of hematochezia events were benign hematochezia (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<0.01) and smaller (3.7 vs 4kg, p<0.01). 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 cultures were all negative.

Conclusion

The majority of infants with CHD with hematochezia have BH over NEC, though single ventricle and surgical patients remain at higher risk. Infants <45 days are more vulnerable for developing NEC. Bloodwork was non-contributory in identification of cardiac NEC. Expansion to a prospective study to develop a treatment algorithm is important to avoid over-treatment.