Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-30T14:41:37.516Z Has data issue: false hasContentIssue false
  • English
  • Français

Early hybrid approach and enteral feeding algorithm could reduce the incidence of necrotising enterocolitis in neonates with ductus-dependent systemic circulation

Published online by Cambridge University Press:  17 March 2016

Lucia Manuri ,
Stefano Morelli ,
Salvatore Agati ,
Michele B. Saitta ,
Lilia Oreto ,
Giuseppe Mandraffino ,
Enrico Iannace ,
Fiore S. Iorio  and
Paolo Guccione
Lucia Manuri*
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Stefano Morelli
Affiliation:
Department of Pediatric Cardiac Intensive Care, Bambino Gesù Children’s Hospital, Rome, Italy
Salvatore Agati
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Michele B. Saitta
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Lilia Oreto
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Giuseppe Mandraffino
Affiliation:
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Enrico Iannace
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Fiore S. Iorio
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
Paolo Guccione
Affiliation:
Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Taormina, Italy
*
Correspondence to: L. Manuri, MD, Cardiovascular Department, Mediterranean Pediatric Cardiology Center, Bambino Gesù Children’s Hospital, Contrada Sirina, CAP 98039, Taormina, Italy. Tel: +39 348 722 5861; +39 094 257 9558; Fax: +39 094 257 9573; E-mail: lucia.manuri@opbg.net
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Hybrid approachhypoplastic left heart syndromenecrotising enterocolitis
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 1 , January 2017 , pp. 154 - 160
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.Google Scholar
2. Niemarkt, HJ, de Meij, TG, van de Velde, ME, et al. Necrotizing enterocolitis: a clinical review on diagnostic biomarkers and the role of the intestinal microbiota. Inflamm Bowel Dis 2015; 21: 436–444.Google Scholar
3. Jeffries, HE, Wells, WJ, Starnes, VA, et al. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2006; 81: 982–987.Google Scholar
4. Palmer, SR, Biffin, A, Gamsu, HR. Outcome of neonatal necrotising enterocolitis: results of the BAPM/CDSC surveillance study, 1981–84. Arch Dis Child 1989; 64: 388–394.CrossRefGoogle ScholarPubMed
5. Giannone, PJ, Luce, WA, Nankervis, CA, et al. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82: 341–347.Google Scholar
6. Galantowicz, M, Cheatham, JP. Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome. Pediatr Cardiol 2005; 26: 190–199.Google Scholar
7. Galantowicz, M, Cheatham, JP, Phillips, A, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 2008; 85: 2063–2071.Google Scholar
8. Luce, WA, Schwartz, RM, Beauseau, W, et al. Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease. Pediatr Crit Care Med 2011; 12: 46–51.Google Scholar
9. Shore, S, Nelson, DP, Pearl, JM. Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically ill infants with congenital heart disease. Am J Cardiol 2001; 88: 591–594.Google Scholar
10. Slicker, J, Hehir, DA, Horsley, M, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis. 2013; 8: 89–102.Google Scholar
11. Del Castillo, SL, McCulley, ME, Khemani, RG, et al. 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 2010; 11: 373–377.Google Scholar
12. Brown, EG, Sweet, AY. Preventing necrotizing enterocolitis in neonates. JAMA 1978; 240: 2452–2454.Google Scholar
13. Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome post stage I palliation. Pediatr Crit Care Med 2009; 10: 460–466.Google Scholar
14. Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328–333.Google Scholar
15. Willis, L, Thureen, P, Kaufman, J, et al. Enteral feeding in prostaglandin-dependent neonates: is it a safe practice? J Pediatr 2008; 153: 867–869.Google Scholar
16. Theilen, U, Shekerdemian, L. The intensive care of infants with hypoplastic left heart syndrome. Arch Dis Child Fetal Neonatal Ed 2005; 90: F97-F102.Google Scholar
17. Hoffman, GM, Tweddell, JS, Ghanayem, NS, et al. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg 2004; 127: 738–745.Google Scholar
18. Furck, AK, Hansen, JH, Uebing, A, Scheewe, J, Jung, O, Kramer, H-H. The impact of afterload reduction on the early postoperative course after the Norwood operation – a 12-year single-centre experience. Eur J Cardiothorac Surg 2010; 37: 289–295.Google Scholar
19. Nakano, T, Kado, H, Shiokawa, Y, et al. The low resistance strategy for the perioperative management of the Norwood procedure. Ann Thorac Surg 2004; 77: 908–912.CrossRefGoogle ScholarPubMed
20. Bianchi, MO, Cheung, PY, Phillipos, E, Aranha-Netto, A, Joynt, C. The effect of milrinone on splanchnic and cerebral perfusion in infants with congenital heart disease prior to surgery: an observational study. Shock 2015; 44: 115–120.Google Scholar
21. Cozzi, CT, Galantowicz, M, Cheatham, JP, et al. Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation. Cardiol Young 2014; 25: 1074–1079.Google Scholar
22. Harrison, AM, Davis, S, Reid, JR, et al. Neonates with hypoplastic left heart syndrome have ultrasound evidence of abnormal superior mesenteric artery perfusion before and after modified Norwood procedure. Pediatr Crit Care Med 2005; 6: 445–447.Google Scholar
23. Lequier, LL, Nikaidoh, H, Leonard, SR, et al. Preoperative and postoperative endotoxemia in children with congenital heart disease. Chest 2000; 117: 1706–1712.Google Scholar
24. Malagon, I, Onkenhout, W, Klok, G, et al. Gut permeability in paediatric cardiac surgery. Br J Anaesth 2005; 94: 181–185.Google Scholar
25. Cheung, YF, Ho, MH, Cheng, VY. Mesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation. Ann Thorac Surg 2003; 75: 947–951.Google Scholar
26. Kozik, DJ, Tweddell, JS. Characterizing the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg 2006; 81: S2347–S2354.Google Scholar
27. Mou, SS, Haudek, SB, Lequier, L, et al. Myocardial inflammatory activation in children with congenital heart disease. Crit Care Med 2002; 30: 827–832.Google Scholar