Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease.
OBJECTIVE
To investigate the prevalence of necrotizing enterocolitis (NEC) in neonates undergoing the Stage I hybrid procedure for palliation of complex congenital heart disease (CHD). Neonates undergoing the Norwood surgery for hypoplastic left-heart syndrome have the highest risk for NEC of all CHD patients. The hybrid procedure is another palliative option for hypoplastic left-heart syndrome, but NEC in neonates undergoing this procedure has not been reported.


METHODS
Retrospective chart review of 73 neonates who underwent the hybrid procedure for palliation of complex CHD. Demographic, perinatal, perioperative, clinical, and procedural data were collected. NEC was defined as modified Bell's Stage II and above.


METHODS
The cardiothoracic and neonatal intensive care units in a large free-standing children's hospital.


METHODS
All neonates who underwent the hybrid Stage I procedure for the palliation of complex CHD from April 2002 through April 2008.


RESULTS
Seventy-three neonates were reviewed and 11.0% (eight of 73) developed NEC. Of the patients with NEC, 37.5% (three of eight) died and two patients required abdominal surgery. Earlier gestational age (< 37 wks), lower maximum dose of prostaglandin infusion, and unexpected readmission to the intensive care unit were statistically associated with NEC (p = .009, 0.02, and 0.04, respectively). No other demographic, perinatal, perioperative, clinical, or procedural variables were associated with the development of NEC in this patient population, including enteral feeding regimens, umbilical artery catheters, inotrope use, and average oxygen saturation and diastolic blood pressure.


CONCLUSIONS
The prevalence of NEC in patients undergoing the hybrid procedure is comparable to that reported for neonates undergoing the Norwood procedure. Earlier gestational age is a significant risk factor for NEC in patients who undergo the hybrid Stage I procedure. Multidisciplinary approaches to better understand abdominal complications and to develop feeding regimens in neonates undergoing the hybrid approach to complex CHD are needed to improve outcomes and decrease morbidities.
Luce
Wendy A
WA
Department of Pediatrics, Ohio State University, Columbus, OH, USA. wendy.luce@nationwidechildrens.org
Schwartz
Randall M
RM
Beauseau
Wendi
W
Giannone
Peter J
PJ
Boettner
Beth L
BL
Cheatham
John P
JP
Galantowicz
Mark E
ME
Cua
Clifford L
CL
D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D058327:Norwood Procedures; D009820:Ohio; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome