Key learning points from a CHD necrotising enterocolitis learning collaborative across high- and low-performing centres

Authors

Hani Siddeek, University of Utah, Department of Pediatrics, Division of Pediatric Cardiology, Salt Lake City, UT, USA.
Jamie M. Furlong-Dillard, Norton Children's Hospital/University of Louisville, Department of Pediatrics, Division of Pediatric Critical Care, Louisville, KY, USA.
David K. Bailly, University of Utah, Department of Pediatrics, Division of Pediatric Critical Care, Salt Lake City, UT, USA.
Mario Briceno-Medina, Le Bonheur Children's Hospital - University of Tennessee, Department of Pediatrics, Division of Pediatric Cardiology, Memphis, TN, USA.
Deborah U. Frank, University of Virginia Health Children's, Department of Pediatrics, Division of Pediatric Critical Care, Charlottesville, VA, USA.
Amanda Hogan, Advocate Health - Midwest
Brandon Kirkland, University of Utah, Department of Pediatrics, Division of Pediatric Critical Care, Salt Lake City, UT, USA.
Laura A. Ortmann, University of Nebraska Medical Center, Department of Pediatrics, Division of Pediatric Critical Care, Omaha, NE, USA.
Piyagarnt Vichayavilas, Advocate Health - Midwest
Jeffrey G. Weiner, Monroe Carell Jr Children's Hospital at Vanderbilt, Department of Pediatrics, Division of Pediatric Cardiology, Nashville, TN, USA.
Melissa Winder, https://ror.org/03r0ha626University of Utah, Department of Pediatrics, Division of Pediatric Cardiology, Salt Lake City, UT, USA.
Erin E. Gordon, Advocate Health - MidwestFollow
Kevin L. Hummel, Phoenix Children's, Division of Cardiovascular ICU, Phoenix, AZ, USA.

Recommended Citation

Siddeek H, Furlong-Dillard JM, Bailly DK, et al. Key learning points from a CHD necrotising enterocolitis learning collaborative across high- and low-performing centres. Cardiol Young. 2025;35(11):2291-2296. doi:10.1017/S1047951125110068

Affiliations

Advocate Children's Hospital

Abstract

Objective: Patients with CHD are at risk for developing necrotising enterocolitis. Currently, no standardised approaches for identification, diagnosis, and treatment of necrotising enterocolitis exists, and there are varying rates and management strategies of necrotising enterocolitis across centres. We used the Paediatric Cardiac Critical Care Consortium to identify high- and low-performing centres based on necrotising enterocolitis rates and convened a necrotising enterocolitis working group. The aims of the group were to understand why variability exists, identify risk factors, and create a foundation for a prospective improvement project.

Methods: Nine centres participated, and collaborative learning sessions were held with multidisciplinary input. REDCap surveys were disseminated to centres to create consensus among site practices and recommendations.

Results: The following topics were discussed: diagnosis, risk factors, and management. Diagnosis consensus suggests (1) Diagnosis would benefit from a comprehensive scoring tool, and (2) ultrasound may serve as a highly sensitive diagnostic tool for those at high risk with the absence of other radiologic findings of necrotising enterocolitis. Risk factor consensus suggests (1) those with ductal-dependent systemic blood flow are the highest risk, and (2) vasopressors with splanchnic constriction should be used with caution. Management consensus suggests (1) breastmilk be used first-line for feeding, 2) resume feeds 24-48 hours after a necrotising enterocolitis rule-out, and 3) surgical deference to physical examination and laboratory evaluation above radiographic findings.

Conclusion: Variability exists in diagnosing necrotising enterocolitis and feeding approaches for at-risk patients. Opportunities exist for collaboration to standardise definitions, compare outcomes, identify risk factors, and create consensus on the management of necrotising enterocolitis.

Document Type

Article

PubMed ID

41140048