Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease*

Abstract

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.

Diastolic Flow Parameters Are Not Sensitive in Predicting Necrotizing Enterocolitis in Patients Undergoing Hybrid Procedure

“…One alternative palliative procedure for these patients is the hybrid procedure, consisting of bilateral pulmonary artery banding, patent ductus arteriosus (PDA) stenting, and balloon atrial septostomy . We previously reported that the incidence of NEC in patients undergoing the hybrid procedure was 11% . Lower gestational age and lower prostaglandin dosage were the only risk factors found in patients who developed NEC after the hybrid procedure.…”

Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis

“…The incidence of NEC is high in neonates with congenital heart disease, especially in those patients with single ventricle physiology . The immediate short‐term outcomes have been described, but less is known about mid‐term outcomes in this population.…”

“…Since bypass times were not different between groups, this would suggest that at least some of the technical aspects of the surgery were not major contributing factors in the development of NEC. It must also be added that since NEC occurs in patients undergoing the hybrid procedure as well, which does not require cardiopulmonary bypass, it may be the overall underlying physiology of a circuit in parallel versus series that places these patients at increased risk for NEC and not just the fact of undergoing cardiopulmonary bypass . The ability to accurately determine the presence of residual lesions after the surgical procedure and decisions to intervene or not intervene were difficult to ascertain from the database, so no comment was made on those issues to determine if there were differences in those variables.…”

“…The incidence of necrotizing enterocolitis (NEC) is higher in neonates with congenital heart disease (CHD) when compared with healthy term infants. In particular, neonates with single ventricle physiology are at increased risk for NEC during their initial hospitalization when they undergo the first stage of congenital heart repair . NEC is associated with substantial morbidity and mortality in these patients .…”

“…NEC is associated with substantial morbidity and mortality in these patients . Potential short‐term consequences for any neonate that develops NEC include an increased risk of infectious and hematologic complications, the need for ostomy and/or prolonged total parental nutrition, and death …”