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Necrotizing enterocolitis (NEC) is a devastating gastrointestinal illness that affects high-risk populations such as those with congenital heart disease (CHD). A diagnosis of NEC, before and after cardiac surgery, can have serious and irreversible consequences. Here, we review perioperative management strategies that could potentially reduce the incidence of NEC in CHD. The literature is rich in investigative work regarding NEC in preterm infants; however, these data are extrapolated to infants with CHD. The pathogenesis of NEC in CHD is thought to be multifactorial, with splanchnic hypoperfusion being a major contributor. The data suggest that early enteral feeding with human milk, the use of probiotics, thoughtful use of red blood cell transfusions, and near-infrared spectroscopy may be useful tools in the prevention of NEC. NEC is an illness with the potential for high morbidity and mortality, particularly in CHD. Therefore, prevention of NEC should be the clinician’s focus when caring for these infants. Well-designed studies and evidence-based guidelines to standardize care in these infants are much needed to improve the outcome of NEC.

OBJECTIVES/HYPOTHESIS Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection. STUDY DESIGN Retrospective chart review. METHODS This is a retrospective chart review of infants (age

Objective To evaluate the hypothesis that feeding volumes exceeding 100 mL/kg/d and exposure to cow's milk formula preoperatively increase the risk for preoperative necrotizing enterocolitis (NEC) in infants with complex congenital heart disease. Study design All infants, of any gestational age, with an isolated cardiac lesion at high risk for NEC (ductal-dependent lesions, transposition of the great arteries, truncus arteriosus, and aorto-pulmonary window) admitted to Texas Children's Hospital from 2010 to 2016 were included. NEC was defined based on the modified Bell criteria. Feeding regimen information and relevant covariates were collected. Logistic regression was used to evaluate the association of feeding regimen and other potential risk factors with NEC. Results In this single-center, retrospective cohort of 546 infants, 3.3% developed Bell stage I-III NEC preoperatively. An exclusive unfortified human milk diet was associated with a significantly lower risk of preoperative NEC (OR 0.17, 95% CI 0.04-0.84, P = .03) in a multivariable regression model controlling for cardiac lesion, race, feeding volume, birth weight small for gestational age, inotrope use presurgery/pre-NEC, and prematurity. Feeding volumes exceeding 100 mL/kg/d were associated with a significantly greater risk of preoperative NEC (OR 3.05, 95% CI 1.19-7.90, P = .02). Conclusions The findings suggest that an unfortified exclusive human milk diet may reduce the risk of preoperative NEC in infants with complex congenital heart disease.