Pierick Alyson R, Liken Hillary, Zampi Jeffrey D, Romano Jennifer C, Strohacker Courtney, Lowery Ray, Yu Sunkyung, Duimstra Ashley, Sower C Todd
Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, 1405 East Hospital Dr., Ann Arbor, MI, 48109, USA.
Section of Pediatric Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
Pediatr Cardiol. 2024 Nov 10. doi: 10.1007/s00246-024-03704-5.
Hybrid stage 1 palliation (HS1P) is used as an alternative to the surgical Norwood for single ventricle patients and specific other conditions. Necrotizing enterocolitis (NEC) occurs in 5%-18% of infants after surgical Norwood, contributing to significant morbidity. We sought to compare the NEC incidences in HS1P versus Norwood patients. A single-center retrospective cohort study of all infants undergoing HS1P or Norwood over a 12-year period. Demographics, underlying cardiac diagnosis, surgical details, and NEC episodes were queried for each patient. The cumulative incidences of NEC between HS1P and Norwood patients were compared. A total of 305 infants were included; 200 Norwood and 105 HS1P. HS1P infants were more often premature (gestational age < 37 weeks; 23.8% vs 1.5%) and had lower birth weight (mean 2.8 ± 0.66 kg versus 3.3 ± 0.47 kg) than their Norwood counterparts. Most infants who underwent the Norwood procedure had hypoplastic left heart syndrome (79.5%), with variable underlying cardiac diagnosis for those who underwent HS1P. Incidence of NEC was significantly higher in the HS1P group (53.3% versus 37.0%, p = 0.01), with increased risk independent of birth weight or underlying cardiac diagnosis (adjusted odds ratio 1.8, p = 0.03). Infants after HS1P had a median of 2 episodes of NEC (interquartile range [IQR] 1-3) versus 1 episode in the Norwood group (IQR 1-2). Infants after HS1P are at higher risk of NEC in comparison to infants after the Norwood procedure. More studies are needed to help predict which infants after HS1P are at highest risk for NEC.
混合一期姑息治疗（HS1P）被用作单心室患者及特定其他病症的诺伍德手术替代方案。坏死性小肠结肠炎（NEC）在接受诺伍德手术的婴儿中发生率为5%-18%，会导致严重的发病情况。我们试图比较HS1P患者与接受诺伍德手术患者的NEC发生率。一项对12年间所有接受HS1P或诺伍德手术的婴儿进行的单中心回顾性队列研究。查询了每位患者的人口统计学信息、潜在心脏诊断、手术细节和NEC发作情况。比较了HS1P患者与接受诺伍德手术患者之间NEC的累积发生率。共纳入305名婴儿；200名接受诺伍德手术，105名接受HS1P。与接受诺伍德手术的婴儿相比，接受HS1P的婴儿早产（胎龄<37周；23.8%对1.5%）更为常见，出生体重更低（平均2.8±0.66千克对3.3±0.47千克）。大多数接受诺伍德手术的婴儿患有左心发育不全综合征（79.5%），而接受HS1P的婴儿潜在心脏诊断各不相同。HS1P组的NEC发生率显著更高（53.3%对37.0%，p=0.01），风险增加与出生体重或潜在心脏诊断无关（调整后的优势比为1.8，p=0.03）。接受HS1P的婴儿NEC发作中位数为2次（四分位间距[IQR]1-3），而诺伍德组为1次（IQR 1-2）。与接受诺伍德手术的婴儿相比，接受HS1P的婴儿发生NEC的风险更高。需要更多研究来帮助预测哪些接受HS1P的婴儿发生NEC的风险最高。
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