Necrotizing Enterocolitis in Infants with Hybrid Stage 1 Palliation is Common and Difficult to Predict

Hybrid stage 1 palliation (HS1P) is performed at many centers for patients with single ventricle heart disease or complex biventricular heart disease and high-risk features. Necrotizing enterocolitis (NEC) is common in these infants, although specific risk factors have not been identified to predict those who will develop NEC. A single-center retrospective chart review of 105 infants who underwent HS1P at < 30 days of age was performed. Clinical, procedural, and echocardiographic features at HS1P and prior to NEC episodes were collected. Hypoplastic left heart syndrome accounted for 54.3% of patients. HS1P was performed at a median of 5 days of life, with 78.1% having a ductal stent placed and 35.2% having an atrial septal intervention. Overall, 56 infants (53.3%) developed NEC prior to their next surgery. Stage 1 NEC occurred in 42 infants (75.0%), with stage 2/3 NEC occurring in 14 infants (25.0%). Having three or more risk factors leading to the decision to undergo HS1P was associated with development of NEC (p = 0.01). Infants with stage 2/3 NEC were more likely to receive a general surgery consult (100% vs. 33.3%), had longer NPO times (median 7 vs. 3 days), longer antibiotic course (median 7 vs. 4 days), longer hospital length of stay (median 73.5 vs. 43 days), and were less likely to be discharged home prior to next surgical intervention (28.6% vs. 47.6%) than those with stage 1 NEC (all p < 0.05). Infants undergoing HS1P are at high risk for NEC with a significant impact on patients' clinical courses.