Frontiers in Pediatrics (Aug 2024)

Impact of postoperative necrotizing enterocolitis after neonatal cardiac surgery on neurodevelopmental outcome at 1 year of age

  • Walter Knirsch,
  • Alexandra De Silvestro,
  • Verena Rathke,
  • Christelle L’Ebraly,
  • Christelle L’Ebraly,
  • Julia C. Natterer,
  • Juliane Schneider,
  • Nicole Sekarski,
  • Beatrice Latal,
  • Cristina Borradori-Tolsa,
  • Maya S. Bouhabib,
  • Katharina Fuhrer Kradolfer,
  • Martin Glöckler,
  • Damian Hutter,
  • Marc R. Pfluger,
  • Lena Kaiser,
  • Angelo Polito,
  • Janet F. Kelly-Geyer,
  • Michael von Rhein,
  • the Swiss ORCHID group,
  • Nicole Sekarski,
  • Julia C. Natterer,
  • Juliane Schneider,
  • Christelle L’Ebraly,
  • Rene Pretre,
  • Amir-Reza Hosseinpour,
  • Maya S. Bouhabib,
  • Angelo Polito,
  • Cristina Borradori-Tolsa,
  • Tornike Sologashvili,
  • Damian Hutter,
  • Lena Kaiser,
  • Marc Raphael Pfluger,
  • Martin Glöckler,
  • Katharina Fuhrer-Kradolfer,
  • Sebastian Grunt,
  • Therese Fahrni,
  • Alexander Kadner,
  • Walter Knirsch,
  • Michael von Rhein,
  • Ruth Etter,
  • Verena Rathke,
  • Janet F. Kelly-Geyer,
  • Beatrice Latal,
  • Hitendu Dave,
  • Robert Cesnjevar,
  • Mark Brotzmann,
  • Hannah Kümin,
  • Rachel Kusche,
  • Christa Killer,
  • Ursula Speckle,
  • Regula Schmid,
  • Barbara Goeggel-Simonetti,
  • Letizia von Laer,
  • Seraina Calonder Faas,
  • Margreet Duetz,
  • Marc Ecoffey,
  • Marie Pascale Metrailler,
  • David Wille,
  • Berenice Bubl

DOI
https://doi.org/10.3389/fped.2024.1380582
Journal volume & issue
Vol. 12

Abstract

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ObjectivesWe analyzed the impact of postoperative necrotizing enterocolitis (NEC) after cardiac surgery in neonatal age on neurodevelopmental (ND) outcome at 1 year of age.MethodsUsing data from the Swiss Neurodevelopmental Outcome Registry for Children with Congenital Heart Disease (ORCHID), we analyzed perioperative variables including postoperative NEC (Bell's stage ≥2) and 1-year ND outcome (Bayley III).ResultsThe included patients (n = 101) had congenital heart disease (CHD), categorized as follows: 77 underwent biventricular repair for CHD with two functional chambers, 22 underwent staged palliation until the Fontan procedure for CHD with single ventricle physiology (n = 22), or 4 underwent single ventricle palliation or biventricular repair for borderline CHD (n = 4). Neonatal cardiopulmonary bypass (CBP) surgery was performed at a median age (IQR) of 8 (6) days. NEC occurred in 16 patients. Intensive care unit (ICU) length of stay (LOS) and the total duration of the hospitalization were longer in children with NEC than those in others (14 with vs. 8 days without NEC, p < 0.05; 49 with vs. 32 days without NEC, p < 0.05). The Bayley III scores of the analyzed patients determined at an age of 11.5 ± 1.5 months showed cognitive (CCS) (102.2 ± 15.0) and language scores (LCS) (93.8 ± 13.1) in the normal range and motor composite scores (MCS) (88.7 ± 15.9) in the low-normal range. After adjusting for socioeconomic status and CHD type, patients with NEC had lower CCS scores [β = −11.2 (SE 5.6), p = 0.049]. Using a cumulative risk score including NEC, we found a higher risk score to be associated with both lower CCS [β = −2.8 (SE 1.3), p = 0.030] and lower MCS [β = −3.20 (SE 1.3), p = 0.016].ConclusionsPostoperative NEC is associated with longer ICU and hospital LOS and contributes together with other complications to impaired ND outcome at 1 year of age. In the future, national and international patient registries may provide the opportunity to analyze large cohorts and better identify the impact of modifiable perioperative risk factors on ND outcome. Clinical Trial RegistrationClinicalTrials.gov identifier: NCT05996211.

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