Risk factors for complications of necrotizing enterocolitis in term neonates with congenital heart disease at a referral hospital in Colombia: A retrospective cohort study

Introduction: Necrotizing enterocolitis (NEC) is one of the most severe complications in neonates and infants. However, term infants with congenital heart disease (CHD) represent a scenario of multiple complications due to pathophysiological mechanisms that differ from the classic pathogenesis. The objective of the study was to determine factors associated with complications of NEC in term infants hospitalized for CHD in a pediatric intensive care unit of a referral hospital in Colombia between 2010 and 2023. Materials and Methods: A retrospective cohort study was conducted, including 148 term infants with CHD who developed NEC during their hospitalization. Demographic and clinical characteristics were analyzed. Descriptive and bivariate analyses were performed using the Chi-square and Mann–Whitney U -tests. A multivariate analysis was conducted using robust Poisson regression with Stata 18.0® software. Results: The most frequent CHD were hypoplastic left heart syndrome (HLHS), pulmonary atresia, and persistent ductus arteriosus. The most common NEC stages were IIa (38.5%) and IIb (23.7%), which were associated with complications such as short bowel syndrome (18.8%) and post-surgical sepsis (37.5%). Among factors related to complications from NEC, medical-surgical management increased the risk (adjusted relative risk: 10.14 and 95% confidence interval: 1.95–48.72), while cardiac surgery reduced the likelihood of complications. Conclusions: NEC in infants with CHD is associated with multiple factors currently under investigation, which may explain a pathophysiological mechanism distinct from that of classic NEC.