S Pradham et al. J Pediatr 2024; 269: 113992. Management of Hematochezia in Infants with Congenital Heart Disease Admitted to the Acute Care Cardiology Unit: A Multicenter Retrospective Pilot Study

Methods: This was a multicenter retrospective review of patient characteristics and evaluation of all hematochezia events in patients (n=121 patients with 180 events) with CHD <6 months admitted to acute care cardiology unit at 3 high-volume tertiary care centers from February 2019 to January 2021. In total, 61% of affected patients had single-ventricle physiology (38% hypoplastic left heart syndrome). Most patients (81%) were full-term.

Key findings:

• 77% of hematochezia events were benign, and 23% were due to necrotizing enterocolitis (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.
• Bloodwork (CBC, WBC, CRP, Blood Culture) did not aid diagnosis

My take: If concerned about NEC which is increased in those with congenital heart disease, obtain an AXR. Overall, the outcomes of NEC in this cohort were good –all resolved with medical management.

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