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Viswanathan S, F Ong KJ, Kakavand B. Prevalence and Risk Factors for Tube-Feeding at Discharge in Infants following Early Congenital Heart Disease Surgery: A Single-Center Cohort Study. Am J Perinatol 2024; 41:e2832-e2841. [PMID: 37848045 DOI: 10.1055/s-0043-1775976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Oral feeding difficulty is common in infants after congenital heart disease (CHD) surgical repair and is associated with prolonged hospital stay and increased risk for tube-feeding at discharge (TF). The current understanding of the enteropathogenesis of oral feeding difficulty in infants requiring CHD surgery is limited. To determine the prevalence and risk factors for TF following CHD surgery in early infancy. STUDY DESIGN This was a 6-year single-center retrospective cohort study (2016-2021) of infants under 6 months who had CHD surgery. Infants required TF were compared with infants who reached independent oral feeding (IOF). RESULTS Of the final sample of 128 infants, 24 (18.8%) infants required TF at discharge. The risk factors for TF in univariate analysis include low birth weight, low 5-minute Apgar score, admitted at birth, risk adjustment in congenital heart surgery categories IV to VI, presence of genetic diagnosis, use of Prostin, higher pre- and postsurgery respiratory support, lower weight at surgery, lower presurgery oral feeding, higher presurgery milk calory, delayed postsurgery enteral and oral feeding, higher pre- and postsurgery gastroesophageal reflux disease (GERD), need for swallow study, abnormal brain magnetic resonance imaging (p < 0.05). In the multivariate analysis, only admitted at birth, higher presurgery milk calories, and GERD were significant risk factors for TF. TF had significantly longer hospital stay (72 vs. 17 days) and lower weight gain at discharge (z-score: -3.59 vs. -1.94) compared with IOF (p < 0.05). CONCLUSION The prevalence of TF at discharge in our study is comparable to previous studies. Infants with CHD admitted at birth, received higher presurgery milk calories, and clinical GERD are significant risk factors for TF. Mitigating the effects of identified risk factors for TF will have significant impact on the quality of life for these infants and their families and may reduce health care cost. KEY POINTS · Oral feeding difficulty in infants after congenital heart disease surgical repair is common.. · Such infants require prolonged hospital stay and higher risk for tube-feeding at discharge.. · Identifying modifiable risk factors associated with tube-feeding can enhance clinical outcomes..
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Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida
| | - Kaitlyn Jade F Ong
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida
| | - Bahram Kakavand
- Department of Pediatrics, Division of Pediatric Cardiology, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida
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Ascencio A, Fingland S, Diaz-Miron J, Weber N, Hills-Dunlap J, Partrick D, Acker SN. Operative Complications Following Gastrostomy Tube Placement After Cardiac Surgery During Infancy. J Surg Res 2024; 296:203-208. [PMID: 38281355 DOI: 10.1016/j.jss.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/27/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Gastrostomy tube (GT) placement is common in infants following repair of congenital heart defects. We aimed to determine rate of operative complications and predictors of short-term GT use to counsel parents regarding the risks and benefits of GT placement. METHODS We reviewed infants aged <1 y with congenital heart disease who underwent GT placement after cardiac surgery between 2018 and 2021. Demographics and clinical data were collected and analyzed. Comparisons were made between infants who required the GT for more than 1 y and those who required the GT for less than 1 y. RESULTS One hundred thirty three infants were included; 35 (26%) suffered one or more complication including wound infection (4, 3%), granulation tissue (3, 2%), tube dislodgement (10), leakage from the tube (9), unplanned emergency department visit (15), and unplanned readmission (1). Thirty-four infants used the GT for feeds for 1 y or less (26%) including 17 (13%) who used it for 3 mo or less. Fifty-six infants had their GT removed during the study period (42%), 20 of whom required gastrocutaneous fistula closure (36%). Thirty-three infants had a GT placed on or before day of life 30, 17 (52%) used the GT for less than 1 y, and 10 (31%) used it for 3 mo or less. CONCLUSIONS GT placement is associated with a relatively high complication and reoperation rate. GT placement in infants aged less than 30 d is associated with shorter duration of use. Risks, benefits, and alternatives such as nasogastric tube feeds should be discussed in the shared decision-making process for selected infants.
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Affiliation(s)
- Andy Ascencio
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Stephanie Fingland
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Nell Weber
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Jonathan Hills-Dunlap
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - David Partrick
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
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Cullis PS, Lam J, Dass D, Munro F, Patkowski D. Letter to the Editor in Response to: What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures? J Pediatr Surg 2024:S0022-3468(24)00085-X. [PMID: 38403491 DOI: 10.1016/j.jpedsurg.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Paul Stephen Cullis
- Department of Paediatric Surgery, Royal Hospital for Children & Young People, Edinburgh, UK; University of Edinburgh, Edinburgh, UK.
| | - Jimmy Lam
- Department of Paediatric Surgery, Royal Hospital for Children & Young People, Edinburgh, UK
| | - Dipankar Dass
- Department of Paediatric Surgery, Royal Hospital for Children & Young People, Edinburgh, UK
| | - Fraser Munro
- Department of Paediatric Surgery, Royal Hospital for Children & Young People, Edinburgh, UK
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland
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Yildirim MI, Spaeder MC, Castro BA, Chamberlain R, Fuzy L, Howard S, McNaull P, Raphael J, Sharma R, Vizzini S, Wielar A, Frank DU. The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial. Pediatr Cardiol 2024; 45:426-432. [PMID: 37853163 DOI: 10.1007/s00246-023-03322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Neonates who require surgery for congenital heart disease (CHD) frequently have difficulty with oral feeds post-operatively and may require a feeding tube at hospital discharge. The purpose of this study was to determine the effect of oral or nasal intubation route on feeding method at hospital discharge. This was a non-blinded randomized control trial of 62 neonates who underwent surgery for CHD between 2018 and 2021. Infants in the nasal (25 patients) and oral (37 patients) groups were similar in terms of pre-operative risk factors for feeding difficulties including completed weeks of gestational age at birth (39 vs 38 weeks), birthweight (3530 vs 3100 g), pre-operative PO intake (92% vs 81%), and rate of pre-operative intubation (22% vs 28%). Surgical risk factors were also similar including Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category (3.9 vs 4.1), shunt placement (32% vs 41%), cardiopulmonary bypass time (181 vs 177 min), and cross-clamp time (111 vs 105 min). 96% of nasally intubated patients took full oral feeds by discharge as compared with 78% of orally intubated infants (p = 0.05). Nasally intubated infants reach full oral feeds an average of 3 days earlier than their orally intubated peers. In this cohort of patients, nasally intubated infants reach oral feeds more quickly and are less likely to require supplemental tube feeding in comparison to orally intubated peers. Intubation route is a potential modifiable risk factor for oral aversion and appears safe in neonates. The study was approved by the University of Virginia Institutional Review Board for Health Sciences Research and was retrospectively registered on clinicaltrials.gov (NCT05378685) on May 18, 2022.
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Affiliation(s)
- Melissa I Yildirim
- Division of Pediatric Cardiology, Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Michael C Spaeder
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Barbara A Castro
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Chamberlain
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lisa Fuzy
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sarah Howard
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Peggy McNaull
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jacob Raphael
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ruchik Sharma
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Samantha Vizzini
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Amy Wielar
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Deborah U Frank
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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