Preoperative and postoperative CHD-associated necrotizing enterocolitis differ in terms of clinical severity, detection patterns, and hemodynamic background, suggesting CHD-NEC may not be a uniform entity.
Preoperative CHD-NEC was associated with a substantially higher intestinal perforation rate compared with postoperative CHD-NEC.
Preoperative CHD-NEC demonstrated more severe metabolic derangement than postoperative CHD-NEC at the time of NEC onset.
Postoperative CHD-NEC was more frequently detected through imaging findings, particularly portal venous gas on ultrasonography.
Preoperative CHD-NEC was more frequently identified after the onset of bloody stool compared with postoperative CHD-NEC.
The overall study cohort included 55 NEC episodes in 47 infants, classified into three groups: classical NEC, preoperative CHD-NEC, and postoperative CHD-NEC.
CHD-NEC was identified as a heterogeneous entity, with preoperative and postoperative forms representing distinct clinical phenotypes.
This research suggests that necrotizing enterocolitis (NEC), a serious intestinal disease, behaves differently depending on whether it occurs before or after heart surgery in infants with congenital heart disease (CHD). The study analyzed 55 NEC episodes in 47 infants and found that NEC occurring before heart surgery (preoperative CHD-NEC) was more severe: it was associated with higher rates of intestinal perforation (a life-threatening complication), worse acid-base balance, higher lactate levels indicating poor tissue oxygenation, and lower levels of a clotting protein called antithrombin III. These babies also more commonly showed obvious symptoms like bloody stools before NEC was recognized. In contrast, NEC occurring after heart surgery (postoperative CHD-NEC) appeared to be detected more often through imaging surveillance — particularly by finding portal venous gas (air bubbles in a major liver vein) on ultrasound — rather than through overt clinical symptoms. This suggests that postoperative cases may be caught at an earlier stage through routine monitoring, while preoperative cases may declare themselves more dramatically through clinical deterioration. This research suggests that CHD-associated NEC is not a single uniform disease but rather encompasses at least two distinct clinical patterns with different presentations, severity levels, and likely different underlying causes. This distinction is important because it implies that these two groups of patients may need different monitoring strategies and treatment approaches, and that combining them as a single group in future research could obscure meaningful differences in outcomes and risk factors.
Koga S, Miyazaki K, Tamaki A, Kuraoka A, Nagata H, Hayashida M. (2026). Heterogeneity of necrotizing enterocolitis associated with congenital heart disease: a comparative study of preoperative and postoperative clinical phenotypes.. Pediatric surgery international. https://doi.org/10.1007/s00383-026-06646-6