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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: [email protected]
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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 

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