Gastrostomy Tube Feeding after Neonatal Complex Cardiac Surgery Identifies the Need for Early Developmental Intervention

Ricci, M Florencia; Alton, Gwen Y.; Dicken, Bryan; Moddemann, Diane; Robertson, Charlene M.T.; Rebeyka, Ivan M.; Guerra, Gonzalo Garcia; Atallah, Joseph; Dinu, Irena A.; Blakley, Patricia M.; Bodani, Jay; Synnes, Anne

doi:10.1016/j.jpeds.2015.10.087

Cited by 17 publications

(22 citation statements)

References 28 publications

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“…Finally, our findings highlight the differences between patients with and without CHD, both in terms of baseline characteristics as well as outcomes after IL. Previous work has shown that neonates with CHD have high rates of delays in cognitive, motor, and language development . Feeding difficulties are prevalent in this group, independent of the presence of vocal fold immobility, with higher risk cardiac surgeries and longer intubation periods conferring an increase of feeding difficulty.…”

Section: Discussionmentioning

confidence: 97%

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

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Objective: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.Methods: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre-and postprocedure, incidence of aspiration-related sequelae, and adverse events.Results: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.Conclusion: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.

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Section: Discussionmentioning

confidence: 97%

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

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“…White children were the most represented ethnicity (Table S2). Within the set of 18 papers, three 24,61,62 were derived from a single infant study; 17 two papers 63,64 were derived from another infant study; 26 another two papers from a single study; 65,66 and one was a follow-up paper 67 from an infant Newburger et al 45 Robertson et al 32 Garcia Guerra et al(a) 41 Garcia Guerra et al(b) 41 Cheatham et al 46 Hicks et al 47 Joynt et al 48 Ricci et al 49 Alton et al 50 Freed et al 51 Atallah et al(a) 34 Atallah et al(b) 34 Mackie et al(a) 43 Mackie et al(b) 43 Mackie et al(c) 43 Mackie et al(d) 43 Mackie et al 52 Goldberg et al 53 Gunn et al 30 Andropoulos et al 22 Bellinger et al 23 Fuller et al 37 Acton et al(a) 44 Acton et al(b) 44 Acton et al(c) 44 Acton et al(d) 44 Acton et al(e) 44 Aly et al(a) 42 Aly et al(b) 42 Li et al 54 Gunn et al 27 Newburger et al 45 Robertson et al 32 Garcia Guerra et al(a) 41 Garcia Guerra et al(b)…”

Section: Preschool Age: 25 Months Up To and Including 4 Years 6 Monthsmentioning

confidence: 99%

Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta‐analysis

Huisenga

Gemert

Bergen

et al. 2020

Develop Med Child Neuro

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Aim (1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta‐regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool‐aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes. Method We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed. Results In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single‐ventricle CHD was inferior to those with two‐ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes. Interpretation The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes.

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“…Early feeding difficulties have been shown to be important predictors of later developmental delays. 6,25,27,28 Infants who 7,8 require early speech therapy may warrant increased vigilance to monitor for further delays. An expert panel of child development specialists has recommended that early intervention be started within 2 months of diagnosis in preterm infants in order to capitalise on the neuroplasticity of the infant brain, 29 which may allow early intervention to be more effective.…”

Section: Discussionmentioning

confidence: 99%

“…Early feeding difficulties have been shown to be important predictors of later developmental delays 6 25 , 27 , 28 Infants who require early speech therapy may warrant increased vigilance to monitor for further delays.…”

Section: Discussionmentioning

confidence: 99%

Utilisation of early intervention services in young children with hypoplastic left heart syndrome

et al. 2017

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Objective Children with hypoplastic left heart syndrome are at a risk for neurodevelopmental delays. Current guidelines recommend systematic evaluation and management of neurodevelopmental outcomes with referral for early intervention services. The Single Ventricle Reconstruction Trial represents the largest cohort of children with hypoplastic left heart syndrome ever assembled. Data on life events and resource utilisation have been collected annually. We sought to determine the type and prevalence of early intervention services used from age 1 to 4 years and factors associated with utilisation of services. Methods Data from 14-month neurodevelopmental assessment and annual medical history forms were used. We assessed the impact of social risk and geographic differences. Fisher exact tests and logistic regression were used to evaluate associations. Results Annual medical history forms were available for 302 of 314 children. Greater than half of the children (52–69%) were not receiving services at any age assessed, whereas 20–32% were receiving two or more therapies each year. Utilisation was significantly lower in year 4 (31%) compared with years 1–3 (with a range from 40 to 48%) (p < 0.001). Social risk factors were not associated with the use of services at any age but there were significant geographic differences. Significant delay was reported by parents in 18–43% of children at ages 3 and 4. Conclusion Despite significant neurodevelopmental delays, early intervention service utilisation was low in this cohort. As survival has improved for children with hypoplastic left heart syndrome, attention must shift to strategies to optimise developmental outcomes, including enrolment in early intervention when merited.

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Gastrostomy Tube Feeding after Neonatal Complex Cardiac Surgery Identifies the Need for Early Developmental Intervention

Cited by 17 publications

References 28 publications

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta‐analysis

Utilisation of early intervention services in young children with hypoplastic left heart syndrome

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