The Effect of Single Ventricle Congenital Heart Disease on Recurrence Risk of Pneumatosis Intestinalis in Neonates

Background: Congenital heart disease (CHD) is a known risk factor for the development of pneumatosis intestinalis (PI). CHD can be divided into double ventricle physiology (DVP) and single ventricle physiology (SVP). SVP is significant because systemic forward flow can be altered in this disease process which can affect bowel perfusion and potentially lead to increased incidence of PI, worsened cases of PI, or increased risk of recurrence for PI. We hypothesized that patient with SVP would have increased risk of recurrent PI.

Methods: A retrospective review was completed from 10/2014 through 05/2020 with patients that fit the following criteria: ECHO diagnosis of forward-flow altering CHD, radiographic evidence of PI, and less than one year of age. Groups were divided into those with SVP and those with DVP. Primary outcome was radiographic recurrence of PI and secondary outcomes were average antibiotic duration, NPO duration, median length of stay, need for GI operation, and death from PI. A separate analysis was done to evaluate predictors of PI recurrence.

Results: A total of 51 patients were included in our analysis, 34 with SVP and 17 with DVP. There was no significant difference in gender, birthweight, if they were receiving enteral feeds at the time of diagnosis, blood in stool at the time of diagnosis, bypass time, or cross-clamp time. Double ventricle patients were significantly more likely to be pre-term and have longer circulatory arrest times during their cardiac repairs. In our study, 26.47% of SVP had recurrence of PI whereas no DVP experienced a recurrence of PI. There was no significant difference in antibiotic duration, NPO duration, median length of stay, need for operative procedure, or death from PI. Patients with recurrences were significantly more likely to have increased hospital LOS, longer antibiotic duration, and longer NPO duration, but there was no difference in death related to PI or all-cause mortality.

Conclusion: Our data suggests that patients with single ventricle physiology are more likely to have recurrence of radiographic PI. Unsurprisingly those that recur they have longer LOS, antibiotic and NPO duration. This suggests that we may need to consider single ventricle patients that get PI as their own separate group when determining their antibiotic and NPO length.