Feeding outcomes in post-discharge feeding clinic for infants following cardiac surgery

Abstract

Introduction: The aim of this study was to describe the development and assess the usefulness of a feeding clinic to help infants with CHD tolerate the highest level of oral feeding while achieving growth velocity and supporting neurodevelopment. Materials and methods: This retrospective, cohort study assessed feeding outcomes for infants who underwent cardiac surgery at <30 days of age with cardiopulmonary bypass between February 2016 and April 2020. Diagnoses, age at surgery, hospitalisation variables, and feeding outcomes were compared between two cohorts, pre- and post-implementation of a specialised feeding clinic using Exact Wilcoxon signed-rank test, chi-squared, or Fisher’s exact test. The association between time to full oral feed and risk factors was assessed using univariable and multivariable Cox regression model. Results: Post-clinic infants (n = 116) surgery was performed at a median of 6 days of life (interquartile range: 4, 8) with median hospital length of stay of 19 days (interquartile range: 16, 26). Infants’ median age at first clinic visit was at 30 days old (interquartile range: 24, 40) and took median 10 days (interquartile range: 7, 12) after hospital discharge to first clinic visit. In the post-clinic cohort, the median time to 100% oral feeding was 47 days (interquartile range: 27, 96) compared to the 60 days (interquartile range: 20, 84) in the pre-clinic cohort (n = 22), but the difference was not statistically significant. Discussion: The cardiac feeding clinic was utilised by our neonatal surgery population and feasible in coordination with cardiology follow-up visits. Future assessment of cardiac feeding clinic impact should include additional measures of feeding and neurodevelopmental success.

What are the needs and challenges of breastfed medically complex infants and children in the paediatric setting?

“…These problems are commonly researched in the cardiac population, since fatigue is a frequent cause of feeding disruption for these infants (Jones et al, 2021). One study found that post cardiac surgery the most common problems included fatigue, poor tone, weakness, need for respiratory support and pain (Jones et al, 2022). Another study instigated a program involving speech and language therapists, occupational therapists, physiotherapists, nurses and lactation consultants to develop teaching to support nursing staff to identify when infants require altered feeding practices due to physiological instability.…”