Enteral Feeding of Neonates with Congenital Heart Disease

Abstract

Background: Despite their putative impact on post-operative outcomes, there is paucity of data on enteral feeding practices of neonates with congenital heart disease (CHD). Objectives: To examine feeding patterns among neonates with CHD before and after surgical repair and determine the incidence of and to identify risk factors associated with feeding-related morbidities. Methods: Retrospective data review of neonates with CHD who underwent surgical repair within the first month of life. SPSS software (version 17) was used for analyses and p < 0.05 taken as significant. Results: The median (range) gestational age of our cohort (n = 67) was 39 weeks (32–41) and birth weight 3,100 g (1,615–4,280). Ductal-dependent lesions were diagnosed in 52 infants (77.6%). Prior to surgery, feedings were initiated in 62 infants (92.5%) at a median age of 2.5 days (1–18); 100 ml/kg daily intake was achieved in 47 infants (70.1%) at 5 days (1–20) and full feeds in 22 infants (32.8%). Postoperative enteral feeds were started 3 days (1–20) after surgery in 66 infants (98.5%) and intake of 100 ml/kg/day was reached in 64 infants at 5 postoperative days (1–29). Four infants (5.9%) died; 27 (40.3%) were on at least partial gavage feedings at the time of discharge home. NEC was diagnosed in 2 infants. On regression analysis, cardiopulmonary bypass (p = 0.024) and age at which full feeds were attained prior to surgery (p = 0.039) were significantly associated with death and/or gavage at discharge. Conclusions: The majority of infants with CHD achieve moderate enteral intake prior to surgery, even while on prostaglandins. Despite this and the early initiation of postoperative enteral feeds, many infants need gavage feeds at discharge. Evidence-based feeding strategies for this high-risk population are critical to improving outcomes.

Nutrition and growth in congenital heart disease

“…In a survey of 200 caregivers, routine preoperative feeding in prostaglandindependent infants ranged from 56% (US) to 93% (outside the US). In two separate studies, it appears that feeding prostaglandin-dependent infants is safe, with no increase in necrotizing enterocolitis [40][41][42]. While there is a general assumption that preoperative enteral nutrition may lead to improved feeding behaviors postsurgery, there was no difference in the need for nasogastric feedings at discharge between presurgical and postsurgical feeding groups [40].…”

Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding

“…Significant growth failure is well-recognized in infants undergoing congenital heart defect surgery due to multiple factors including increased metabolic demand, delayed enteral feeding secondary to prostaglandin infusion, risk of mesenteric hypoperfusion, and prolonged intubation (Golbus, Wojcik, Charpie, & Hirsch, 2011). While feeding algorithms have reduced the number of days to reach full enteral feeds (Braudis et al, 2009; Slicker et al, 2013), patients with cyanotic heart disease often continue to need nasogastric or gastrostomy tube feeds at discharge due to poor oral feeding skills (Jadcherla, Vijayapal, & Leuthner, 2009; Natarajan, Reddy Anne, & Aggarwal, 2010). Various studies have found that the proportion of neonates with CHD requiring tube feeding at discharge ranges from 29% to 45% (Einarson & Arthur, 2003; Kogon et al, 2007).…”

Feeding Dysfunction in Children with Single Ventricle Following Staged Palliation

“…These include an increased risk of slow growth and feeding disorders(5,8). Of all cardiac defects, patients with single ventricle lesions most frequently manifest feeding problems both at time of initial discharge and at 2 year follow up(5,9). …”