Massachusetts Chapter of the American College of Surgeons

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A Role for Abdominal Ultrasound in Evaluating Bowel Ischemia in Congenital Heart Disease Patients with Suspected Necrotizing Enterocolitis
Stefanie P. Lazow1, Sarah A. Tracy1, Judy A. Estroff1, Richard B. Parad2, Ilse M. Castro-Aragon3, Alan M. Fujii3, Steven J. Staffa1, David Zurakowski1, Catherine Chen1
1Boston Children's Hospital, Boston, MA; 2Brigham and Women's Hospital, Boston, MA; 3Boston Medical Center, Boston, MA

Background: We evaluated the diagnostic utility of abdominal ultrasound (AUS), an emerging adjunct to abdominal x-ray (AXR), for suspected necrotizing enterocolitis (NEC) in congenital heart disease (CHD) patients.
Methods: 86 patients with suspected NEC from 2009-2018 were classified as with CHD (n=18) if they required cardiac intervention (excluding PDA ligation) versus without CHD (n=68). Clinical and radiological data from the admission were collected. Concordance between the first paired AXR and AUS within a 24-hour period was evaluated. Wilcoxon rank sum test, Fisher’s exact test, and Z-test for independent proportions were performed.
Results: CHD patients had higher birth weights (median 2.4 vs. 1.0 kg; p<0.001) and gestational ages (median 37 vs. 28 weeks; p<0.001) than non-CHD patients, and they presented with more hypotension (p=0.041) and less bilious emesis (p<0.001). On concordance analysis, CHD patients had 3.9-fold more discordant study pairs with positive AXR, but negative AUS for pneumatosis than non-CHD patients (33.3% vs. 8.8%; Z-test = 2.67, p=0.008); no CHD patients with this discordance pattern required surgery. Throughout their hospital course, CHD patients were less likely to have pneumatosis (33.3% vs. 72.1%; p=0.005) and decreased bowel mural flow (0% vs. 20.6%; p=0.035) on AUS than non-CHD patients. Urgent surgical intervention was required in 5.6% of CHD patients versus 16.2% of non-CHD patients. NEC-related mortality was 0% in CHD patients versus 5.9% in non-CHD patients. Conclusions: CHD patients with suspected NEC may represent a distinct clinical population. AUS may have utility in helping to rule out bowel ischemia in CHD patients.


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