Skip to main content
Erschienen in: Pediatric Cardiology 4/2018

01.02.2018 | Original Article

Necrotizing Enterocolitis in Infants with Hypoplastic Left Heart Syndrome Following Stage 1 Palliation or Heart Transplant

verfasst von: Nahed O. ElHassan, Xinyu Tang, Jeffrey Gossett, Dala Zakaria, Ashley Ross, Sashi K. Kona, Parthak Prodhan

Erschienen in: Pediatric Cardiology | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Previous studies of necrotizing enterocolitis (NEC) among infants with hypoplastic left heart syndrome (HLHS) were conducted in single centers or had small sample sizes. This study aimed to determine the mortality rate and the risk factors for NEC among infants with HLHS who were discharged over a 10-year period (2004–2013) from 41 Pediatric Health Information System affiliated children’s hospitals. Either stage 1 palliation and/or heart transplant were completed prior to patient’s death or hospital discharge. We compared the characteristics of infants with HLHS who did not develop NEC and those who developed medical or surgical NEC and of patients who had medical vs. surgical NEC. The primary outcome was mortality over time and by birth weight category (low birth weight [LBW], birth weight < 2500 vs. ≥ 2500 g). Multivariable analyses were performed to identify the risk factors for developing NEC and for mortality among infants with HLHS. The study evaluated 5720 infants with HLHS including 349 patients (6.1%) with medical or surgical NEC. Fifty-two patients (0.9%) required laparotomy or percutaneous abdominal drainage. On univariable analysis, the overall mortality rate for infants who developed NEC was significantly higher than infants who did not develop NEC (23.5 vs. 13.9%, P < 0.001). On multivariable analysis, neither medical nor surgical NEC was a significant predictor of mortality in the study population. LBW infants were at higher risk for mortality in both the univariable and the multivariable models. Nevertheless, LBW did not significantly predispose infants with HLHS to develop NEC. Our results provide a national benchmark incidence of NEC, its risk factors, and outcomes among a large cohort of infants with HLHS and establish that NEC is not a significant risk factor for mortality in this population.
Literatur
1.
Zurück zum Zitat McElhinney DB, Hedrick HL, Bush DM et al (2000) Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106:1080–1087CrossRefPubMed McElhinney DB, Hedrick HL, Bush DM et al (2000) Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106:1080–1087CrossRefPubMed
2.
Zurück zum Zitat Stoll BJ, Kanto WP, Glass RI, Nahmias AJ, Brann AW (1980) Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr 96:447–451CrossRefPubMed Stoll BJ, Kanto WP, Glass RI, Nahmias AJ, Brann AW (1980) Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr 96:447–451CrossRefPubMed
3.
Zurück zum Zitat Cozzi C, Aldrink J, Nicol K, Nicholson L, Cua C (2013) Intestinal location of necrotizing enterocolitis among infants with congenital heart disease. J Perinatol 33:783–785CrossRefPubMed Cozzi C, Aldrink J, Nicol K, Nicholson L, Cua C (2013) Intestinal location of necrotizing enterocolitis among infants with congenital heart disease. J Perinatol 33:783–785CrossRefPubMed
4.
Zurück zum Zitat Pickard SS, Feinstein JA, Popat RA, Huang L, Dutta S (2009) Short- and long-term outcomes of necrotizing enterocolitis in infants with congenital heart disease. Pediatrics 123:e901–e906CrossRefPubMed Pickard SS, Feinstein JA, Popat RA, Huang L, Dutta S (2009) Short- and long-term outcomes of necrotizing enterocolitis in infants with congenital heart disease. Pediatrics 123:e901–e906CrossRefPubMed
5.
Zurück zum Zitat Luce WA, Schwartz RM, Beauseau W et al (2011) Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease. Pediatr Crit Care Med 12:46–51CrossRefPubMed Luce WA, Schwartz RM, Beauseau W et al (2011) Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease. Pediatr Crit Care Med 12:46–51CrossRefPubMed
6.
Zurück zum Zitat Motta C, Scott W, Mahony L et al (2015) The association of congenital heart disease with necrotizing enterocolitis in preterm infants: a birth cohort study. J Perinatol 35:949–953CrossRefPubMed Motta C, Scott W, Mahony L et al (2015) The association of congenital heart disease with necrotizing enterocolitis in preterm infants: a birth cohort study. J Perinatol 35:949–953CrossRefPubMed
7.
Zurück zum Zitat Fisher JG, Bairdain S, Sparks EA et al (2015) Serious congenital heart disease and necrotizing enterocolitis in very low birth weight neonates. J Am Coll Surg 220:1018–1026.e14CrossRefPubMed Fisher JG, Bairdain S, Sparks EA et al (2015) Serious congenital heart disease and necrotizing enterocolitis in very low birth weight neonates. J Am Coll Surg 220:1018–1026.e14CrossRefPubMed
8.
Zurück zum Zitat Cheng W, Leung MP, Tam PK (1999) Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease. Pediatr Surg Int 15:492–495CrossRefPubMed Cheng W, Leung MP, Tam PK (1999) Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease. Pediatr Surg Int 15:492–495CrossRefPubMed
10.
Zurück zum Zitat Llanos AR, Moss ME, Pinzon MC, Dye T, Sinkin RA, Kendig JW (2002) Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinatal Epidemiol 16:342–349CrossRef Llanos AR, Moss ME, Pinzon MC, Dye T, Sinkin RA, Kendig JW (2002) Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinatal Epidemiol 16:342–349CrossRef
11.
12.
Zurück zum Zitat Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2008) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29:713–717CrossRefPubMed Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2008) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29:713–717CrossRefPubMed
13.
Zurück zum Zitat Kalfa D, Krishnamurthy G, Levasseur S et al (2015) Norwood stage I palliation in patients less than or equal to 2.5 kg: outcomes and risk analysis. Ann Thorac Surg 100:167–173CrossRefPubMed Kalfa D, Krishnamurthy G, Levasseur S et al (2015) Norwood stage I palliation in patients less than or equal to 2.5 kg: outcomes and risk analysis. Ann Thorac Surg 100:167–173CrossRefPubMed
14.
Zurück zum Zitat Dees E, Lin H, Cotton RB, Graham TP, Dodd DA (2000) Outcome of preterm infants with congenital heart disease. J Pediatr 137:653–659CrossRefPubMed Dees E, Lin H, Cotton RB, Graham TP, Dodd DA (2000) Outcome of preterm infants with congenital heart disease. J Pediatr 137:653–659CrossRefPubMed
15.
Zurück zum Zitat Fletcher DM (2004) Achieving data quality. How data from a pediatric health information system earns the trust of its users. J AHIMA 75:22–26PubMed Fletcher DM (2004) Achieving data quality. How data from a pediatric health information system earns the trust of its users. J AHIMA 75:22–26PubMed
16.
Zurück zum Zitat Abdullah F, Zhang Y, Camp M et al (2010) Necrotizing enterocolitis in 20,822 infants: analysis of medical and surgical treatments. Clin Pediatr 49:166–171CrossRef Abdullah F, Zhang Y, Camp M et al (2010) Necrotizing enterocolitis in 20,822 infants: analysis of medical and surgical treatments. Clin Pediatr 49:166–171CrossRef
17.
Zurück zum Zitat Spong CY (2013) Defining “term” pregnancy: recommendations from the defining “Term” pregnancy workgroup. JAMA 309:2445–2446CrossRefPubMed Spong CY (2013) Defining “term” pregnancy: recommendations from the defining “Term” pregnancy workgroup. JAMA 309:2445–2446CrossRefPubMed
18.
Zurück zum Zitat Bates D, Maechler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48CrossRef Bates D, Maechler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48CrossRef
19.
Zurück zum Zitat Miller TA, Minich LL, Lambert LM, Joss-Moore L, Puchalski MD (2014) Abnormal abdominal aorta hemodynamics are associated with necrotizing enterocolitis in infants with hypoplastic left heart syndrome. Pediatr Cardiol 35:616–621CrossRefPubMed Miller TA, Minich LL, Lambert LM, Joss-Moore L, Puchalski MD (2014) Abnormal abdominal aorta hemodynamics are associated with necrotizing enterocolitis in infants with hypoplastic left heart syndrome. Pediatr Cardiol 35:616–621CrossRefPubMed
20.
Zurück zum Zitat Hebra A, Brown MF, Hirschl RB et al (1993) Mesenteric ischemia in hypoplastic left heart syndrome. J Pediatr Surg 28:606–611CrossRefPubMed Hebra A, Brown MF, Hirschl RB et al (1993) Mesenteric ischemia in hypoplastic left heart syndrome. J Pediatr Surg 28:606–611CrossRefPubMed
21.
Zurück zum Zitat Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE (2008) Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 82:341–347CrossRefPubMed Giannone PJ, Luce WA, Nankervis CA, Hoffman TM, Wold LE (2008) Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 82:341–347CrossRefPubMed
22.
Zurück zum Zitat Malagon I, Onkenhout W, Klok M, van der Poel PF, Bovill JG, Hazekamp MG (2005) Gut permeability in neonates after a stage 1 Norwood procedure. Pediatr Crit Care Med 6:547–549CrossRefPubMed Malagon I, Onkenhout W, Klok M, van der Poel PF, Bovill JG, Hazekamp MG (2005) Gut permeability in neonates after a stage 1 Norwood procedure. Pediatr Crit Care Med 6:547–549CrossRefPubMed
23.
Zurück zum Zitat Torres A (2011) Classic Norwood versus Sano modification versus hybrid approach: necrotizing enterocolitis or no necrotizing enterocolitis? Pediatr Crit Care Med 12:109–110CrossRefPubMed Torres A (2011) Classic Norwood versus Sano modification versus hybrid approach: necrotizing enterocolitis or no necrotizing enterocolitis? Pediatr Crit Care Med 12:109–110CrossRefPubMed
24.
Zurück zum Zitat Maayan-Metzger A, Itzchak A, Mazkereth R, Kuint J (2004) Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol 24:494–499CrossRefPubMed Maayan-Metzger A, Itzchak A, Mazkereth R, Kuint J (2004) Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol 24:494–499CrossRefPubMed
25.
Zurück zum Zitat Dean PJ, McHugh KE, Conaway MR, Hillman DG, Gutgesell HP (2013) Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome. Pediatr Cardiol 34:1829–1836CrossRefPubMedPubMedCentral Dean PJ, McHugh KE, Conaway MR, Hillman DG, Gutgesell HP (2013) Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome. Pediatr Cardiol 34:1829–1836CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Czosek RJ, Anderson JB, Heaton PC et al (2013) Staged palliation of hypoplastic left heart syndrome: trends in mortality, cost, and length of stay using a national database from 2000 through 2009. Am J Cardiol 111:1792–1799CrossRefPubMed Czosek RJ, Anderson JB, Heaton PC et al (2013) Staged palliation of hypoplastic left heart syndrome: trends in mortality, cost, and length of stay using a national database from 2000 through 2009. Am J Cardiol 111:1792–1799CrossRefPubMed
27.
Zurück zum Zitat Hornik CP, He X, Jacobs JP et al (2012) Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg 93:1992–1997CrossRefPubMedPubMedCentral Hornik CP, He X, Jacobs JP et al (2012) Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg 93:1992–1997CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Karamlou T, Overman D, Hill KD et al (2015) Stage 1 hybrid palliation for hypoplastic left heart syndrome-assessment of contemporary patterns of use: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Databse. J Thorac Cardiovasc Surg 149:195–202CrossRefPubMed Karamlou T, Overman D, Hill KD et al (2015) Stage 1 hybrid palliation for hypoplastic left heart syndrome-assessment of contemporary patterns of use: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Databse. J Thorac Cardiovasc Surg 149:195–202CrossRefPubMed
29.
Zurück zum Zitat Patole SK, de Klerk N (2005) Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 90:F147–F151CrossRefPubMedPubMedCentral Patole SK, de Klerk N (2005) Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 90:F147–F151CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, Rhine WD (2011) Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol 31(Suppl 1):S61–S67CrossRefPubMed McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, Rhine WD (2011) Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol 31(Suppl 1):S61–S67CrossRefPubMed
31.
Zurück zum Zitat Toms R, Jackson KW, Dabal RJ, Reebals CH, Alten JA (2015) Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 10:36–42CrossRefPubMed Toms R, Jackson KW, Dabal RJ, Reebals CH, Alten JA (2015) Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 10:36–42CrossRefPubMed
32.
Zurück zum Zitat del Castillo SL, McCulley ME, Khemani RG et al (2010) Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 11:373–377PubMed del Castillo SL, McCulley ME, Khemani RG et al (2010) Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 11:373–377PubMed
33.
Zurück zum Zitat Schwalbe-Terilli CR, Hartman DH, Nagle ML et al (2009) Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 18:52–57CrossRefPubMed Schwalbe-Terilli CR, Hartman DH, Nagle ML et al (2009) Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 18:52–57CrossRefPubMed
34.
Zurück zum Zitat Hamilton S, McAleer DM, Ariagno K et al (2014) A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med 15:583–589CrossRefPubMedPubMedCentral Hamilton S, McAleer DM, Ariagno K et al (2014) A stepwise enteral nutrition algorithm for critically ill children helps achieve nutrient delivery goals. Pediatr Crit Care Med 15:583–589CrossRefPubMedPubMedCentral
Metadaten
Titel
Necrotizing Enterocolitis in Infants with Hypoplastic Left Heart Syndrome Following Stage 1 Palliation or Heart Transplant
verfasst von
Nahed O. ElHassan
Xinyu Tang
Jeffrey Gossett
Dala Zakaria
Ashley Ross
Sashi K. Kona
Parthak Prodhan
Publikationsdatum
01.02.2018
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 4/2018
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-018-1820-0

Weitere Artikel der Ausgabe 4/2018

Pediatric Cardiology 4/2018 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.