Pediatric Cardiology

, Volume 39, Issue 4, pp 774–785 | Cite as

Necrotizing Enterocolitis in Infants with Hypoplastic Left Heart Syndrome Following Stage 1 Palliation or Heart Transplant

  • Nahed O. ElHassan
  • Xinyu Tang
  • Jeffrey Gossett
  • Dala Zakaria
  • Ashley Ross
  • Sashi K. Kona
  • Parthak Prodhan
Original Article


Previous studies of necrotizing enterocolitis (NEC) among infants with hypoplastic left heart syndrome (HLHS) were conducted in single centers or had small sample sizes. This study aimed to determine the mortality rate and the risk factors for NEC among infants with HLHS who were discharged over a 10-year period (2004–2013) from 41 Pediatric Health Information System affiliated children’s hospitals. Either stage 1 palliation and/or heart transplant were completed prior to patient’s death or hospital discharge. We compared the characteristics of infants with HLHS who did not develop NEC and those who developed medical or surgical NEC and of patients who had medical vs. surgical NEC. The primary outcome was mortality over time and by birth weight category (low birth weight [LBW], birth weight < 2500 vs. ≥ 2500 g). Multivariable analyses were performed to identify the risk factors for developing NEC and for mortality among infants with HLHS. The study evaluated 5720 infants with HLHS including 349 patients (6.1%) with medical or surgical NEC. Fifty-two patients (0.9%) required laparotomy or percutaneous abdominal drainage. On univariable analysis, the overall mortality rate for infants who developed NEC was significantly higher than infants who did not develop NEC (23.5 vs. 13.9%, P < 0.001). On multivariable analysis, neither medical nor surgical NEC was a significant predictor of mortality in the study population. LBW infants were at higher risk for mortality in both the univariable and the multivariable models. Nevertheless, LBW did not significantly predispose infants with HLHS to develop NEC. Our results provide a national benchmark incidence of NEC, its risk factors, and outcomes among a large cohort of infants with HLHS and establish that NEC is not a significant risk factor for mortality in this population.


Necrotizing enterocolitis Hypoplastic left heart syndrome Stage 1 palliation Heart transplant 



Cardiopulmonary bypass


Cardiac pulmonary resuscitation


Child Health Corporation of America


Congenital heart disease


Confidence interval


Current Procedural Terminology


Clinical Transaction Classification™


Extracorporeal membrane oxygenation


Gastrostomy tube


Hypoplastic left heart syndrome


International Classification of Diseases, Ninth Revision


Low birth weight


Necrotizing enterocolitis


Pediatric Health Information System


Small for gestational age


Relative risk


Very low birth weight


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study received the University of Arkansas for Medical Sciences Institutional Board Review approval and individual consent was waived.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nahed O. ElHassan
    • 1
  • Xinyu Tang
    • 2
  • Jeffrey Gossett
    • 3
  • Dala Zakaria
    • 4
  • Ashley Ross
    • 1
  • Sashi K. Kona
    • 1
  • Parthak Prodhan
    • 5
  1. 1.Department of Pediatrics (Neonatology)University of Arkansas for Medical Sciences, Arkansas Children’s HospitalLittle RockUSA
  2. 2.Department of Pediatrics (Biostatistics)University of Arkansas for Medical Sciences, Arkansas Children’s HospitalLittle RockUSA
  3. 3.Department of Pediatrics (Biostatistics & Cardiology)University of Arkansas for Medical Sciences, Arkansas Children’s HospitalLittle RockUSA
  4. 4.Departments of Pediatrics (Cardiology)University of Arkansas for Medical Sciences, Arkansas Children’s HospitalLittle RockUSA
  5. 5.Department of Pediatrics (Cardiology and Pediatric Intensive Care)University of Arkansas for Medical Sciences, Arkansas Children’s HospitalLittle RockUSA

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