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Necrotizing Enterocolitis in Infants with Hybrid Stage 1 Palliation is Common and Difficult to Predict
Alyson R Pierick1, Hillary Liken2, Jeffrey D Zampi3
1Children's Healthcare of Atlanta Cardiology, Emory University School of Medicine, 2220 North Druid Hills Rd. NE, 30329, Atlanta, GA, Georgia. alyson.r.pierick@emory.edu.
Pediatric Cardiology
|August 8, 2026
Summary
Infants undergoing hybrid stage 1 palliation (HS1P) face a high risk of necrotizing enterocolitis (NEC). Having multiple risk factors for HS1P increases NEC development, impacting patient outcomes and hospital stays.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Gastroenterology
Background:
- Hybrid stage 1 palliation (HS1P) is a critical intervention for infants with complex single or biventricular heart disease.
- Necrotizing enterocolitis (NEC) is a significant postoperative complication in these infants, but predictive risk factors remain unclear.
Purpose of the Study:
- To identify risk factors for NEC development in infants undergoing HS1P.
- To analyze the clinical course and outcomes of infants who develop NEC after HS1P.
Main Methods:
- Retrospective chart review of 105 infants who underwent HS1P before 30 days of age.
- Collection of clinical, procedural, and echocardiographic data.
- Comparison of infants with and without NEC, and between NEC stages.
Main Results:
- Over half (53.3%) of infants developed NEC post-HS1P.
- Three or more pre-HS1P risk factors were associated with NEC development (p=0.01).
- Severe NEC (stage 2/3) correlated with longer NPO times, antibiotic use, hospital stay, and reduced discharge home rates.
Conclusions:
- Infants undergoing HS1P are at substantial risk for NEC.
- Identifying pre-procedural risk factors can aid in early detection and management of NEC.
- NEC significantly complicates the clinical course and resource utilization in this vulnerable population.
