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; 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; Swiss ORCHID group

doi:10.3389/fped.2024.1380582

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

Front Pediatr. 2024 Aug 6:12:1380582. doi: 10.3389/fped.2024.1380582. eCollection 2024.

Authors

Walter Knirsch¹, Alexandra De Silvestro¹, Verena Rathke¹, Christelle L'Ebraly^{2

3}, Julia C Natterer⁴, Juliane Schneider⁵, Nicole Sekarski², Beatrice Latal⁶, Cristina Borradori-Tolsa⁷, Maya S Bouhabib³, Katharina Fuhrer Kradolfer⁸, Martin Glöckler⁹, Damian Hutter⁹, Marc R Pfluger⁹, Lena Kaiser⁹, Angelo Polito¹⁰, Janet F Kelly-Geyer¹¹, Michael von Rhein⁶; Swiss ORCHID group

Collaborators

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

Affiliations

¹ Pediatric Cardiology, Pediatric Heart Center, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland.
² Pediatric Cardiology, Woman-Mother-Child Department, University Hospital Lausanne, Lausanne, Switzerland.
³ Pediatric Cardiology, Woman-Child-Adolescent Department, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Pediatric Intensive Care Unit, Woman-Mother-Child Department, University Hospital Lausanne, Lausanne, Switzerland.
⁵ Neonatology, Woman-Mother-Child Department, University Hospital Lausanne, Lausanne, Switzerland.
⁶ Child Development Center, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland.
⁷ Development and Growth, Department of Pediatrics, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁸ Pediatric Neurology, Bern, Switzerland.
⁹ Pediatric Cardiology, Center for Congenital Heart Disease, Department of Cardiology and Cardiac Surgery, University Children's Hospital, University of Bern, Bern, Switzerland.
¹⁰ Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹¹ Department of Neonatology and Pediatric Intensive Care, Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland.

Abstract

Objectives: We analyzed the impact of postoperative necrotizing enterocolitis (NEC) after cardiac surgery in neonatal age on neurodevelopmental (ND) outcome at 1 year of age.

Methods: Using 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).

Results: The 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].

Conclusions: Postoperative 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 registration: ClinicalTrials.gov identifier: NCT05996211.

Keywords: cardiopulmonary bypass surgery; complications; congenital heart disease; neonates; neurodevelopmental outcome.

© 2024 Knirsch, De Silvestro, Rathke, L'Ebraly, Natterer, Schneider, Sekarski, Latal, Borradori-Tolsa, Bouhabib, Fuhrer Kradolfer, Glöckler, Hutter, Pfluger, Kaiser, Polito, Kelly-Geyer, von Rhein and the Swiss ORCHID group.

Associated data

ClinicalTrials.gov/NCT05996211

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article. Swiss ORCHID was supported by the Swiss Society of Pediatric Cardiology, the Anna Müller Grocholski Foundation, Corelina Foundation, Accentus Charitable Foundation. Walter Knirsch and Alexandra De Silvestro were supported by the Swiss National Foundation (SNFS 320030_184932).