Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease

Lisanti, Amy Jo; Savoca, Melanie; Gaynor, J. William; Mascarenhas, Maria R.; Ravishankar, Chitra; Sullivan, Erin; Pieciak, Karyn; Costarino, Andrew T.; Chen, Jodi; Kennedy, Andrea; Olsen, Robert; Min, Jungwon; Mondal, Antara; Huang, Jing; Irving, Sharon Y.

doi:10.1016/j.jpeds.2020.12.047

Cited by 13 publications

(6 citation statements)

References 31 publications

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“…Feeding protocols or algorithms have been shown to be beneficial for hospitalized patients [26]. In a recent publication, a nutrition pathway for neonates with CHD was associated with an improvement in weight change prior to discharge [28 ▪ ]. Along similar lines, implementation of standardized practices before and after discharge using home monitoring programs for infants with univentricular physiology has been associated with better weight gain in the interstage period [29,30].…”

Section: Nutritional Surveillance and Interventionmentioning

confidence: 98%

Feeding challenges in the newborn with congenital heart disease

Ravishankar

2022

Current Opinion in Pediatrics

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Purpose of reviewFeeding challenges and growth failure are lifelong issues for infants with congenital heart disease. The purpose of this review is to summarize the literature on the topic from North America.Recent findingsDespite recognition of feeding challenges and ongoing national collaboration, >50% of infants with univentricular physiology continue to require supplemental tube feeds at the time of discharge from neonatal surgery. Preoperative feeding is now commonly used in prostaglandin dependent neonates with congenital heart disease. The value of a structured nutritional program with establishment of best practices in nutrition is well recognized in the current era. Despite implementation of these best practices, neonates undergoing cardiac surgery continue to struggle with weight gain prior to discharge. This suggests that there is more to growth than provision of adequate nutrition alone.SummaryThe National Pediatric Cardiology Quality Improvement Collaborative continues to play a major role in optimizing nutrition in infants with congenital heart disease. This among other registries underscores the importance of collaboration in improving overall outcomes for children with congenital heart disease. Nurses should be encouraged to lead both clinical and research efforts to overcome feeding challenges encountered by these children.

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Section: Nutritional Surveillance and Interventionmentioning

confidence: 98%

Feeding challenges in the newborn with congenital heart disease

Ravishankar

2022

Current Opinion in Pediatrics

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“…We note that patients with FUH were of low weight for age at all surgical stages. Previous research has linked low weight to poorer outcomes among children with FUH, improved with feeding interventions, 30 hence this topic merits further exploration in an additional future study.…”

Section: Findings In Contextmentioning

confidence: 97%

Cohort study of intervened functionally univentricular heart in England and Wales (2000–2018)

Hadjicosta

Franklin

Seale

et al. 2021

Heart

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ObjectiveGiven the paucity of long-term outcome data for complex congenital heart disease (CHD), we aimed to describe the treatment pathways and survival for patients who started interventions for functionally univentricular heart (FUH) conditions, excluding hypoplastic left heart syndrome.MethodsWe performed a retrospective cohort study using all procedure records from the National Congenital Heart Diseases Audit for children born in 2000–2018. The primary outcome was mortality, ascertained from the Office for National Statistics in 2020.ResultsOf 53 615 patients, 1557 had FUH: 55.9% were boys and 67.4% were of White ethnic groups. The largest diagnostic categories were tricuspid atresia (28.9%), double inlet left ventricle (21.0%) and unbalanced atrioventricular septal defect (AVSD) (15.2%). The ages at staged surgery were: initial palliation 11.5 (IQR 5.5–43.5) days, cavopulmonary shunt 9.2 (IQR 6.0–17.1) months and Fontan 56.2 (IQR 45.5–70.3) months. The median follow-up time was 10.8 (IQR 7.0–14.9) years and the 1, 5 and 10-year survival rates after initial palliation were 83.6% (95% CI 81.7% to 85.4%), 79.4% (95% CI 77.3% to 81.4%) and 77.2% (95% CI 75.0% to 79.2%), respectively. Higher hazards were present for unbalanced AVSD HR 2.75 (95% CI 1.82 to 4.17), atrial isomerism HR 1.75 (95% CI 1.14 to 2.70) and low weight HR 1.65 (95% CI 1.13 to 2.41), critical illness HR 2.30 (95% CI 1.67 to 3.18) or acquired comorbidities HR 2.71 (95% CI 1.82 to 4.04) at initial palliation.ConclusionAlthough treatment pathways for FUH are complex and variable, nearly 8 out of 10 children survived to 10 years. Longer-term analyses of outcome based on diagnosis (rather than procedure) can inform parents, patients and clinicians, driving practice improvements for complex CHD.

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“…[31][32][33] With a complete nutritional assessment, interventions can be determined to promote growth and development, providing safe perioperative nutrition. [34][35][36][37][38] The dietitian is also a crucial team member in decision and timing of gastrostomy tube placement.…”

Section: Assessmentmentioning

confidence: 99%

Assessment and management of feeding difficulties for infants with complex CHD

et al. 2022

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Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.

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Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease

Cited by 13 publications

References 31 publications

Feeding challenges in the newborn with congenital heart disease

Feeding challenges in the newborn with congenital heart disease

Cohort study of intervened functionally univentricular heart in England and Wales (2000–2018)

Assessment and management of feeding difficulties for infants with complex CHD

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