Infants with certain types of congenital heart disease are at a higher risk of developing a life threatening intestinal disease called necrotizing enterocolitis than those without heart conditions. 

This risk is especially high for newborns with single ventricle disease, such as hypoplastic left heart syndrome, which requires surgery within days of birth.

Now, researchers are trying to better understand how this risk changes for babies with these heart conditions based on the type of initial surgery they receive.

Newly presented data suggest that infants who receive a hybrid stage I palliation – a less invasive alternative for initial treatment – more commonly develop necrotizing enterocolitis compared to those who receive the standard Norwood operation, a complex open heart surgery. 

And this increased risk was associated with longer hospital stays and late feeding difficulty, according to the findings presented at the 2024 American Heart Association scientific sessions in Chicago. 

Besides patients with hypoplastic left heart syndrome, hybrid stage I palliation may be recommended for infants to give them time to grow and be healthy enough for an open heart procedure down the road, such as a biventricular repair or heart transplant, says senior author Jeff Zampi, M.D., pediatric cardiologist at University of Michigan Health C.S. Mott Children’s Hospital.  

“Hybrid procedures are becoming more common for newborns with complex heart conditions who are premature, small or have other characteristics that make open heart surgery a high risk option for them after birth,” Zampi said.

“There are many benefits to this less invasive alternative for some patients, including improved survival, but we’re trying to understand the potential downsides as well. It’s important for families to be counseled on all possible patient outcomes for every treatment that may impact quality of life and length of hospital stays.”

Necrotizing enterocolitis, or NEC, causes an inflammatory process that can lead to intestinal tissue damage and primarily impacts premature babies. 

Exact causes are unclear, but the condition can mean poor feeding, bloating, multi-organ failure, and potentially death.  

This work highlights our cardiologists’ and surgeons’ heart center wide approach to caring for this patient population and looking at multiple factors to better understand their overall health and wellbeing."

-Jeff Zampi, M.D.

Zampi says further studies are needed to better understand the physiologic causes of NEC in babies who undergo the hybrid palliation.

For example, the study doesn’t address baseline risk factors, Zampi says, noting that premature and small babies are often candidates for the alternative treatment but their size also intrinsically puts them at higher risk of NEC.

SEE ALSO: The dangerous intestinal disease fatal to premature babies and vulnerable infants | Michigan Medicine

The 11-year study, which included over 300 patients at Mott between 2011 and 2022, is part of a bigger effort to compare outcomes between different treatment strategies for babies with complex single ventricle heart disease.

“Patients who previously would not have survived without hybrid approaches now have a better chance of survival,” Zampi said.

“We’re learning over time who is better served with different approaches and how different treatments impact long term outcomes.

“This work highlights our cardiologists’ and surgeons’ heart center wide approach to caring for this patient population and looking at multiple factors to better understand their overall health and wellbeing,” he added. “It’s a team-based approach to taking complex problems and collaborating across specialists and sub specialists to find the best answers.”

Additional authors: Alyson Pierick M.D., Hillary Liken M.D., Jennifer Romano M.D., Courtney Strohacker M.D., Ray Lowery, Sunkyung Yu and C Todd Sower M.D.

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