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Ofek Shlomai N, Lazarovitz G, Koplewitz B, Eventov Friedman S. Cumulative Dose of Prostaglandin E1 Determines Gastrointestinal Adverse Effects in Term and Near-Term Neonates Awaiting Cardiac Surgery: A Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1572. [PMID: 37761532 PMCID: PMC10528554 DOI: 10.3390/children10091572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE This study aimed to assess the association between treatment characteristics of prostaglandin E1 including initiation time and duration, maximal and cumulative doses, and adverse effects. DESIGN A retrospective cohort study in which medical records of neonates with duct-dependent lesions were studied for treatment parameters and adverse effects. Multivariable logistic regression model was applied for testing the effect PGE1 variables on outcomes. MAIN OUTCOME MEASURES The primary outcomes of this study were association of adverse effects of PGE1 treatment with maximal dose, cumulative dose, and treatment duration. The secondary outcomes included safety of feeding in infants treated with PGE1. RESULTS Eighty-two infants with duct-dependent lesions receiving PGE1 were included. Several infants who received early PGE1 treatment required ventilation support. Feeds were ceased more often as the cumulative dose and duration of PGE1 treatment increased. Gastrointestinal adverse effects were significantly associated with the cumulative dose of PGE1 and treatment duration. Apneas, hyperthermia, and tachycardia were associated with maximal dose. Our data did not demonstrate a difference in the incidence of NEC associated with characteristics of PGE1 treatment. CONCLUSION Cumulative PGE1 dose is associated with gastrointestinal adverse effects in neonates. Lower doses should be considered in neonates expecting prolonged PGE1 treatment.
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Affiliation(s)
- Noa Ofek Shlomai
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.O.S.); (G.L.)
| | - Gilad Lazarovitz
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.O.S.); (G.L.)
| | - Benjamin Koplewitz
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel;
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (N.O.S.); (G.L.)
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Kataria-Hale J, Gollins L, Bonagurio K, Blanco C, Hair AB. Nutrition for Infants with Congenital Heart Disease. Clin Perinatol 2023; 50:699-713. [PMID: 37536773 DOI: 10.1016/j.clp.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Perioperative malnutrition in infants with congenital heart disease can lead to significant postnatal growth failure and poor short- and long-term outcomes. A standardized approach to nutrition is needed for the neonatal congenital heart disease population, taking into consideration the type of cardiac lesion, the preoperative and postoperative period, and prematurity. Early enteral feeding is beneficial and should be paired with parenteral nutrition to meet the fluid and nutrient needs of the infant.
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Affiliation(s)
- Jasmeet Kataria-Hale
- Department of Pediatrics, Division of Neonatology, Mission Hospital, 509 Biltmore Avenue, Asheville, NC 28801, USA
| | - Laura Gollins
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, MC: A5590, Houston, TX 77030, USA
| | - Krista Bonagurio
- University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Cynthia Blanco
- University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Amy B Hair
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, MC: A5590, Houston, TX 77030, USA.
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Blanco CL, Hair A, Justice LB, Roddy D, Bonagurio K, Williams PK, Machado D, Marino BS, Chi A, Takao C, Gordon EE, Ashrafi A, Cacho N, Pruetz JD, Costello JM, Cooper DS. A Randomized Trial of an Exclusive Human Milk Diet in Neonates with Single Ventricle Physiology. J Pediatr 2022; 256:105-112.e4. [PMID: 36528055 DOI: 10.1016/j.jpeds.2022.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether weight gain velocity (g/kg/day) 30 days after the initiation of feeds after cardiac surgery and other clinical outcomes improve in infants with single ventricle physiology fed an exclusive human milk diet compared with a mixed human and bovine diet. STUDY DESIGN In this multicenter, randomized, single blinded, controlled trial, term neonates 7 days of age or younger with single ventricle physiology and anticipated cardiac surgical palliation within 30 days of birth were enrolled at 10 US centers. Both groups received human milk if fed preoperatively. During the 30 days after feeds were started postoperatively, infants in the intervention group received human milk fortified once enteral intake reached 60 mL/kg/day with a human milk-based fortifier designed for term neonates. The control group received standard fortification with formula once enteral intake reached 100 mL/kg/day. Perioperative feeding and parenteral nutrition study algorithms were followed. RESULTS We enrolled 107 neonates (exclusive human milk = 55, control = 52). Baseline demographics and characteristics were similar between the groups. The median weight gain velocity at study completion was higher in exclusive human milk vs control group (12 g/day [IQR, 5-18 g/day] vs 8 g/day [IQR, 0.4-14 g/day], respectively; P = .03). Other growth measures were similar between groups. Necrotizing enterocolitis of all Bell stages was higher in the control group (15.4 % vs 3.6%, respectively; P = .04). The incidence of other major morbidities, surgical complications, length of hospital stay, and hospital mortality were similar between the groups. CONCLUSIONS Neonates with single ventricle physiology have improved short-term growth and decreased risk of NEC when receiving an exclusive human milk diet after stage 1 surgical palliation. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (www. CLINICALTRIALS gov, Trial ID: NCT02860702).
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Affiliation(s)
- Cynthia L Blanco
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center and University Health, San Antonio, TX.
| | - Amy Hair
- Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lindsey B Justice
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dantin Roddy
- Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Krista Bonagurio
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center and University Health, San Antonio, TX
| | - Patricia K Williams
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Oklahoma Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Desiree Machado
- Pediatric Cardiac ICU, Congenital Heart Center, Shands Hospital University of Florida, Gainesville, FL
| | - Bradley S Marino
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH
| | - Annie Chi
- Division of Neonatology, Cook Children's Medical Center, Fort Worth, TX
| | - Cheryl Takao
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA
| | - Erin E Gordon
- Division of Critical Care, Department of Pediatrics, University of Texas Southwestern. Dallas, TX
| | - Amir Ashrafi
- Department of Pediatrics, Children's Hospital of Orange County, Orange, CA
| | - Nicole Cacho
- Division of Neonatology, Congenital Heart Center, Department of Pediatrics, Shands Hospital University of Florida, Gainesville, FL
| | - Jay D Pruetz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA
| | - John M Costello
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatric Cardiology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Bell D, Suna J, Marathe SP, Perumal G, Betts KS, Venugopal P, Alphonso N. Feeding Neonates and Infants Prior to Surgery for Congenital Heart Defects: Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121856. [PMID: 36553299 PMCID: PMC9776823 DOI: 10.3390/children9121856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Necrotising enterocolitis (NEC) is a significant cause of mortality and morbidity in neonates requiring cardiac surgery. Feeding practices vary significantly across institutions and remain controversial. We conducted a systematic review of the literature and a meta-analysis to identify associations between feeding practices and necrotising enterocolitis. METHODS This study was carried out in accordance with the PRISMA guidelines. A literature search was performed in November 2022 using the Cochrane Central Register, Embase, and Pubmed. Two investigators then independently retrieved eligible manuscripts considered suitable for inclusion. Data extracted included gestational age, birth weight, sex, nature of congenital heart lesion, type of operation performed, time on ventilator, ICU stay, hospital stay, post-operative feeding strategy, and complications. The methodological quality was assessed using the Downs and Black score for all randomised control trials and observational studies. RESULTS The initial search yielded 92 studies. After removing duplicates, there were 85 abstracts remaining. After excluding ineligible studies, 8 studies were included for the meta-analysis. There was no significant risk of NEC associated with pre-operative feeding [OR = 1.22 (95% CI 0.77,1.92)] or umbilical artery catheter placement [OR = 0.91 (95% CI 0.44, 1.89)] and neither outcome exhibited heterogeneity [I2 = 8% and 0%, respectively]. There was a significant association between HLHS and NEC [OR = 2.56 (95% CI 1.56, 4.19)] as well as prematurity and NEC [OR 3.34 (95% CI 1.94, 5.75)] and neither outcome exhibited heterogeneity [I2 = 0% and 0%, respectively]. CONCLUSIONS There was no association between NEC and pre-operative feeding status in neonates awaiting cardiac surgery. Pre-operative feeding status was not associated with prolonged hospital stay or need for tube assisted feeding at discharge. HLHS and prematurity were associated with increased incidence of NEC.
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Affiliation(s)
- Douglas Bell
- The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Jessica Suna
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD 4072, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | - Supreet P. Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD 4072, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | | | - Kim S. Betts
- Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD 4072, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD 4072, Australia
- Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3068-3486
| | - QPCR Group
- QPCR Collaborators: Janelle Johnson, Tom R Karl, Children’s Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia
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Mills KI, Kim JH, Fogg K, Goldshtrom N, Graham EM, Kataria-Hale J, Osborne SW, Figueroa M. Nutritional Considerations for the Neonate With Congenital Heart Disease. Pediatrics 2022; 150:189883. [PMID: 36317972 DOI: 10.1542/peds.2022-056415g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
The importance of nutrition in managing critically ill infants with congenital heart disease (CHD) is foundational to optimizing short- and long-term health outcomes. Growth failure and malnutrition are common in infants with CHD. The etiology of growth failure in this population is often multifactorial and may be related to altered metabolic demands, compromised blood flow to the intestine leading to nutrient malabsorption, cellular hypoxia, inadequate energy intake, and poor oral-motor skills. A dearth of high-quality studies and gaps in previously published guidelines have led to wide variability in nutrition practices that are locally driven. This review provides recommendations from the nutrition subgroup of the Neonatal Cardiac Care Collaborative for best evidence-based practices in the provision of nutritional support in infants with CHD. The review of evidence and recommendations focused on 6 predefined areas of clinical care for a target population of infants <6 months with CHD admitted to the ICU or inpatient ward. These areas include energy needs, nutrient requirements, enteral nutrition, feeding practice, parenteral nutrition, and outcomes. Future progress will be directed at quality improvement efforts to optimize perioperative nutrition management with an increasing emphasis on individualized care based on nutritional status, cardiorespiratory physiology, state of illness, and other vulnerabilities.
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Affiliation(s)
- Kimberly I Mills
- Division of Cardiovascular Critical Care, Department of Cardiology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio.,Contributed equally as co-first authors
| | - Kristi Fogg
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Nimrod Goldshtrom
- Division of Neonatology, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Eric M Graham
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Jasmeet Kataria-Hale
- Division of Neonatology, Department of Pediatrics, Mission Children's Hospital, Asheville, North Carolina
| | - Scott W Osborne
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Mayte Figueroa
- Division of Cardiology and Critical Care, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation. Cardiol Young 2021; 31:191-198. [PMID: 33140711 DOI: 10.1017/s1047951120003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation. METHODS We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay. RESULTS We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay. CONCLUSIONS In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.
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Du N, Cui Y, Xie W, Yin C, Gong C, Chen X. Application effect of initiation of enteral nutrition at different time periods after surgery in neonates with complex congenital heart disease: A retrospective analysis. Medicine (Baltimore) 2021; 100:e24149. [PMID: 33429794 PMCID: PMC7793327 DOI: 10.1097/md.0000000000024149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
Early enteral nutrition (EN) promotes the recovery of critically ill patients, but the initiation time for EN in neonates after cardiac surgery remains unclear.This study aimed to investigate the effect of initiation time of EN after cardiac surgery in neonates with complex congenital heart disease (CHD).Neonates with complex CHD admitted to the CICU from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into the 24-hour Group (initiated at 24 hours after surgery in 2015) (n = 32) and 6-hour Group (initiated at 6 hours after surgery in 2016 and 2017) (n = 66). Data on the postoperative feeding intolerance, nutrition-related laboratory tests (albumin, prealbumin, retinol binding protein), and clinical outcomes (including duration of mechanical ventilation, CICU stay, and postoperative hospital stay) were collected.The incidence of feeding intolerance was 56.3% in 24-hour Group and 39.4%, respectively (P = .116). As compared to 24-hour Group, prealbumin and retinol binding protein levels were higher (160.7 ± 64.3 vs 135.2 ± 28.9 mg/L, P = .043 for prealbumin; 30.7 ± 17.7 vs 23.0 ± 14.1 g/L P = .054 for retinol-binding protein). The duration of CICU stay (9.4 ± 4.5 vs 13.3 ± 10.4 day, P = .049) and hospital stay (11.6 ± 3.0 vs 15.8 ± 10.3 day, P = .028) were shorter in 6-hour Group.Early EN improves nutritional status and clinical outcomes in neonates with complex CHD undergoing cardiac surgery, without significant feeding intolerance.
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Affiliation(s)
| | | | | | - Caixin Yin
- Nursing Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Standardized Perioperative Feeding Protocol Improves Outcomes in Patients With d-Transposition of the Great Arteries Undergoing Arterial Switch Operation. Pediatr Crit Care Med 2020; 21:e789-e794. [PMID: 32433441 DOI: 10.1097/pcc.0000000000002393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether the presence of a standardized feeding protocol improves outcomes in a subset of neonates undergoing cardiac surgery. DESIGN Retrospective cohort study. SETTING Cardiovascular ICU at a freestanding academic children's hospital. PATIENTS Neonates with a diagnosis of d-transposition of the great arteries undergoing arterial switch operation from January 2007 to June 2017. INTERVENTIONS Initiation of perioperative feeding protocols. MEASUREMENTS AND MAIN RESULTS Patients were evaluated before and after implementation of standardized perioperative feeding protocols in neonates with d-transposition of the great arteries undergoing arterial switch operation. Low-risk patients born after initiation of nurse-driven protocols were compared with a similar historical group. Data obtained included time to achievement of feeding goals, with primary outcome being weight gain at hospital discharge. Other measures analyzed included duration of mechanical ventilation and postoperative hospital length of stay. Overall, 33 patients in the protocol group were compared with 44 patients in the historical group. No significant baseline differences existed between the two cohorts. The protocol group achieved improved feeding outcomes in nearly all measured categories, including introduction to enteral feeds preoperatively (91% vs 59%; p < 0.01) and earlier attainment of postoperative full enteral feeds of 120 mL/kg/d (2 vs 5 d; p < 0.01). Protocol patients had significantly improved weight gain at the time of discharge (60 vs 1 g; p < 0.01), while achieving shorter postoperative length of stay (10.1 vs 12.6 d; p = 0.04). CONCLUSIONS An aggressive, but safe, perioperative feeding protocol implemented in a homogenous low-risk neonatal cardiac surgical population improves feeding outcomes, including increased weight gain, as well as decreased postoperative length of stay. Consideration for perioperative feeding protocol implementation and further study should be given.
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Kataria-Hale J, Osborne SW, Hair A, Hagan J, Pammi M. Preoperative Feeds in Ductal-Dependent Cardiac Disease: A Systematic Review and Meta-analysis. Hosp Pediatr 2019; 9:998-1006. [PMID: 31744846 DOI: 10.1542/hpeds.2019-0111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Our aim for this review is to determine if preoperative feeds in neonates with ductal-dependent congenital heart disease are harmful or beneficial. OBJECTIVES To summarize current evidence for preoperative feeding in neonates with ductal-dependent congenital heart disease. DATA SOURCES We used the following databases: Medline, Embase, and Cochrane Central Register of Controlled Trials. STUDY SELECTION We included observational studies in which the following outcomes were addressed: necrotizing enterocolitis (NEC), hospital length of stay (LOS), time to achieve full postoperative enteral feeding, and feeding intolerance. DATA EXTRACTION Two reviewers independently screened each study for eligibility and extracted data. Methodologic quality was assessed by using a standardized item bank, and certainty of evidence for each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS Five retrospective cohort studies were eligible for inclusion, for which risk of bias was significant. When comparing neonates who received preoperative feeds with those who did not, there was no significant difference in NEC (pooled odds ratio = 1.09 [95% confidence interval 0.06-21.00; P = .95]; 3 studies, 6807 participants, very low certainty evidence), hospital LOS (mean of 14 days for those not fed versus 9.9 days for those fed preoperatively; P < .01; 1 study, 57 participants, very low certainty evidence), or feeding intolerance (odds ratio = 2.014 [95% confidence interval 0.079-51.703; P = .67]; 1 study, 56 participants, very low certainty evidence). No data were available for the outcome time to achieve full postoperative enteral feeding. All studies were observational and had small sample sizes. CONCLUSIONS There is insufficient evidence to suggest that preoperative enteral feeds in patients with ductal-dependent cardiac lesions adversely influence the rate of NEC, LOS, or feeding intolerance.
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Affiliation(s)
- Jasmeet Kataria-Hale
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Scott Webb Osborne
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Amy Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Joseph Hagan
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Pletzer SA, Atz AM, Chowdhury SM. The Relationship Between Pre-operative Left Ventricular Longitudinal Strain and Post-operative Length of Stay in Patients Undergoing Arterial Switch Operation Is Age Dependent. Pediatr Cardiol 2019; 40:366-373. [PMID: 30413855 PMCID: PMC6415533 DOI: 10.1007/s00246-018-2018-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Post-operative length of stay (LOS) after the arterial switch operation (ASO) is variable. The association between pre-operative non-invasive measures of ventricular function and post-operative course has not been well established. The aims of this study were to (1) evaluate the relationship between pre-operative non-invasive measures of ventricular function and post-operative LOS and (2) evaluate the change in ventricular function after ASO. METHODS Data were reviewed in consecutive ASO patients between 2010 and 2016. The primary outcome was post-operative LOS. Echocardiograms obtained during the pre-operative period and at the time of discharge were retrospectively analyzed using speckle-tracking echocardiography. Pearson's correlation between patient-specific, pre-operative, and echocardiographic data versus post-operative LOS was assessed. RESULTS Fifty-two patients were included in analyses, 39 neonates and 13 infants. Left ventricular (LV) longitudinal strain correlated with post-operative LOS for infants age > 28 days (r = 0.62, p = 0.03), but not for neonates (r = 0.14, p = 0.40). Operative age (r = - 0.42, p = 0.003), weight at surgery (r = - 0.48, p ≤ 0.001), and cardiopulmonary bypass time (r = 0.30, p = 0.045) also correlated with post-operative LOS. Standard 2D measures of ventricular function did not correlate with post-operative LOS. LV ejection fraction and longitudinal strain worsened post-operatively. CONCLUSION Higher pre-operative LV longitudinal strain (representing worse LV function) is associated with increased post-operative LOS after ASO in infants > 28 days, but not in neonates. LV ejection fraction and longitudinal strain worsened after ASO. Future studies should assess the utility of performing STE in risk stratifying patients prior to ASO.
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Affiliation(s)
- Scott A. Pletzer
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
| | - Shahryar M. Chowdhury
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, MSC 915, 165 Ashley Ave, Charleston, SC 29425, USA
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Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery. Pediatr Crit Care Med 2018; 19:1015-1023. [PMID: 30095748 DOI: 10.1097/pcc.0000000000001694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to validate the Vasoactive-Ventilation-Renal score, a novel disease severity index, as a predictor of outcome in a multicenter cohort of neonates who underwent cardiac surgery. DESIGN Retrospective chart review. SETTING Seven tertiary-care referral centers. PATIENTS Neonates defined as age less than or equal to 30 days at the time of cardiac surgery. INTERVENTIONS Ventilation index, Vasoactive-Inotrope Score, serum lactate, and Vasoactive-Ventilation-Renal score were recorded for three postoperative time points: ICU admission, 6 hours, and 12 hours. Peak values, defined as the highest of the three measurements, were also noted. Vasoactive-Ventilation-Renal was calculated as follows: ventilation index + Vasoactive-Inotrope Score + Δ creatinine (change in creatinine from baseline × 10). Primary outcome was prolonged duration of mechanical ventilation, defined as greater than 96 hours. Receiver operative characteristic curves were generated, and abilities of variables to correctly classify prolonged duration of mechanical ventilation were compared using area under the curve values. Multivariable logistic regression modeling was also performed. MEASUREMENTS AND MAIN RESULTS We reviewed 275 neonates. Median age at surgery was 7 days (25th-75th percentile, 5-12 d), 86 (31%) had single ventricle anatomy, and 183 (67%) were classified as Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category 4 or 5. Prolonged duration of mechanical ventilation occurred in 89 patients (32%). At each postoperative time point, the area under the curve for prolonged duration of mechanical ventilation was significantly greater for the Vasoactive-Ventilation-Renal score as compared to the ventilation index, Vasoactive-Inotrope Score, and serum lactate, with an area under the curve for peak Vasoactive-Ventilation-Renal score of 0.82 (95% CI, 0.77-0.88). On multivariable analysis, peak Vasoactive-Ventilation-Renal score was independently associated with prolonged duration of mechanical ventilation, odds ratio (per 1 unit increase): 1.08 (95% CI, 1.04-1.12). CONCLUSIONS In this multicenter cohort of neonates who underwent cardiac surgery, the Vasoactive-Ventilation-Renal score was a reliable predictor of postoperative outcome and outperformed more traditional measures of disease complexity and severity.
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Enteral Feeding Practices in Infants With Congenital Heart Disease Across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey. Pediatr Crit Care Med 2018; 19:137-144. [PMID: 29206731 DOI: 10.1097/pcc.0000000000001412] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe enteral feeding practices in pre and postoperative infants with congenital heart disease in European PICUs. DESIGN Cross-sectional electronic survey. SETTING European PICUs that admit infants with congenital heart disease pre- and postoperatively. PARTICIPANTS One senior PICU physician or designated person per unit. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Fifty-nine PICUs from 18 European countries responded to the survey. PICU physicians were involved in the nutritional care of children with congenital heart disease in most (76%) PICUs, but less than 60% of units had a dedicated dietician. Infants with congenital heart disease were routinely fed preoperatively in only 63% of the PICUs, due to ongoing concerns around prostaglandin E1 infusion, the presence of umbilical venous and/or arterial catheters, and the use of vasoactive drugs. In three quarters of the PICUs (76%), infants were routinely fed during the first 24 hours postoperatively. Units cited, the most common feeding method, both pre and postoperatively, was intermittent bolus feeds via the gastric route. Importantly, 69% of European PICUs still did not have written guidelines for feeding, but this varied for pre and postoperative patients. CONCLUSIONS Wide variations in practices exist in the nutritional care between European PICUs, which reflects the absence of local protocols and scientific society-endorsed guidelines. This is likely to contribute to suboptimal energy delivery in this particularly vulnerable group.
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