title: Early hybrid approach and enteral feeding algorithm could reduce the incidence of necrotising enterocolitis in neonates with ductus-dependent systemic circulation.
abstract: BACKGROUND
  The reported incidence of necrotising enterocolitis in neonates with complex CHD with ductus-dependent systemic circulation ranges from 6.8 to 13% despite surgical treatment; the overall mortality is between 25 and 97%. The incidence of gastrointestinal complications after hybrid palliation for neonates with ductus-dependent systemic circulation still has to be defined, but seems comparable with that following the Norwood procedure.
  
  
  METHODS
  We reviewed the incidence of gastrointestinal complications in a series of 42 consecutive neonates with ductus-dependent systemic circulation, who received early hybrid palliation associated with a standardised feeding protocol.
  
  
  RESULTS
  The median age and birth weight at the time of surgery were 3 days (with a range from 1 to 10 days) and 3.07 kg (with a range from 1.5 to 4.5 kg), respectively. The median ICU length of stay was 7 days (1-70 days), and the median hospital length of stay was 16 days (6-70 days). The median duration of mechanical ventilation was 3 days. Hospital mortality was 16% (7/42). In the postoperative period, 26% of patients were subjected to early extubation, and all of them received treatment with systemic vasodilatory agents. Feeding was started 6 hours after extubation according to a dedicated feeding protocol. After treatment, none of our patients experienced any grade of necrotising enterocolitis or major gastrointestinal adverse events.
  
  
  CONCLUSIONS
  Our experience indicates that the combination of an "early hybrid approach", systemic vasodilator therapy, and dedicated feeding protocol adherence could reduce the incidence of gastrointestinal complications in this group of neonates. Fast weaning from ventilatory support, which represents a part of our treatment strategy, could be associated with low incidence of necrotising enterocolitis.
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Manuri
authors.affiliation: 2Department of Pediatric Cardiac Intensive Care,Bambino Gesù Children's Hospital,Rome,Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Morelli
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agati
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Michele B
authors.initials: MB
authors.lastname: Saitta
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Lilia
authors.initials: L
authors.lastname: Oreto
authors.affiliation: 3Department of Clinical and Experimental Medicine,University of Messina,Messina,Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mandraffino
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Iannace
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Fiore S
authors.initials: FS
authors.lastname: Iorio
authors.affiliation: 1Cardiovascular Department,Mediterranean Pediatric Cardiology Center,Bambino Gesù Children's Hospital,Taormina,Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Guccione
mesh_terms: D000465:Algorithms; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D058327:Norwood Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Hybrid approach; hypoplastic left heart syndrome; necrotising enterocolitis