Features of the formation of necrotizing enterocolitis in cardiac surgery children patients

Introduction. Currently, despite the rapid development of pediatric cardiac surgery, there is a problem of postoperative dysfunction of the gastrointestinal tract (GIT) in patients. Necrotizing enterocolitis (NEC) remains the most complex and least studied problem in pediatrics, including cardiac surgery. In pediatric cardiac surgery, the decrease in perfusion of the internal organs of the abdominal cavity is due to low perfusion pressure during cardiopulmonary bypass, low cardiac output in the postoperative period, aggravation of sympathetic vasoconstriction due to the stress response to surgery, and the introduction of exogenous catecholamines. Objective: analysis of the features of the development of NEC in cardiac surgery children patients.

Materials and methods. A prospective analysis of thirty cardiac surgery children patients with the development of gastrointestinal dysfunction after surgery was performed. All children underwent standard research methods.

Results. In 63.3% of cases, children showed signs of dynamic intestinal obstruction; 36.7% of newborns have signs of necrotizing enterocolitis of varying degrees. The features of the bacteriological landscape, clinical manifestations and X-ray picture depending on the type of intestinal function disorder are presented. The role of hypoxia, hypoperfusion during cardiopulmonary bypass, the functioning of the open ductus arteriosus in “blue” patients in the formation of the risks of developing necrotizing enterocolitis is shown. Among the studied patients, according to the age structure, there were newborns — 18 (60%) patients, children under 6 months — 10 (33,3%); older than 1 year — 2 (96,6%). An analysis of clinical manifestations in children in the preoperative and postoperative periods showed 19 cases (63.3%) to have signs of dynamic intestinal obstruction. This group of children consisted of 8 newborns (36.8%) and 12 patients of the postnatal period. All patients were after heart surgery (2 patients after narrowing of the pulmonary artery and 10 cases cc were operated on under cardiopulmonary bypass). The most difficult and severe group of patients after heart and vascular surgery were children with congenital heart defects, who developed signs of NEC — 11 patients (36.6%). 10 children were neonates, 1 patient was ovet 5 years. It is shown that the development of such complications including infectious and hypoxic causes, heart failure, the duration of cardiopulmonary bypass and diastolic stealing of vessels is of decisive importance.

Conclusions. Dysfunction of the gastrointestinal tract after heart surgery in children is one of the urgent problems of cardiac surgery. In the group of severe sick patients undergoing prolonged ventilation, morphine infusion, muscle relaxants, with signs of anasarca, the interpretation of the X-ray picture and the clinic of acute surgical pathology in the abdominal cavity may be difficult. NEC, occurred in newborns over the postoperative period, is often not recognized in a timely manner and leads to an unfavourable outcome.

Contribution:
Sarsenbayeva G.I. — concept and design of the study, writing the text;
Kim A.I. — editing and consulting;
Berdibekov A.B. — collection and processing of the material.
Аll co-authors — аpproval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: May 30, 2023
Accepted: June 20, 2023
Published: August 31, 2023

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