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

Abstract

Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children’s hospital. 23 neonates born at ≥ 37 weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7 days for the control group and 40.9 days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI −13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.

Feeding difficulties in young paediatric intensive care survivors: A scoping review

“…The age of child participants ranged from pre-term infant <37 weeks gestational age to 36 months and 25 to 46 years-of-age for parents/caregivers. Four of the seven articles focused on feeding abilities/difficulties amongst infants with CHD following cardiac surgery [35,36,38,39]. Two papers presented feeding difficulties in infants in the NICU, with one of these describing the characteristics of poor feeders and identifying the long term feeding outcomes for pre-term infants [37].…”

“…Bedside programmes that include aspect of positive touch have been reported amongst infants with CHD, but not extended to the wider PICU population. Positive touch programmes encourage parents and health care professionals to complete a set of exercises around the infant's face and mouth with the aim of reducing oral aversion and improving oral intake following ETT intubation and intensive care admission [39].…”

“…Additional risk factors for feeding difficulties in infants undergoing cardiac surgery included the type of cardiac surgery, specifically aortic arch repair, length of cardio-pulmonary bypass time and post-op chest open [35,36,38,39], in addition to withholding of feeds and the presence of gastro-oesophageal reflux disease [39]. Furthermore, the time taken (days) to start oral feeding and time taken (days) to reach full volumes of oral feeds for infants following cardiac surgery, were also reported as risk factors for feeding difficulties [37,38,40,41].…”

Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

“…3,4 Another example is how cardiac anomalies and accompanying surgical correction schedules might impact swallowing at different stages in the recovery process. [5][6][7] In contrast, the expected trajectory of a previously healthy child with acute respiratory viral illness gives a different picture of likely transient swallowing difficulty. 8…”

Preditores clínicos do risco de broncoaspiração em crianças com cardiopatias congênitas

“…Os avanços tecnológicos e nos cuidados médicos, com novas opções de tratamento, têm expandido o tempo de vida de muitos bebês com cardiopatia congênita (Dean et al, 2011;Tikkanen et al, 2018) (Jadcherla et al, 2009;Sables-Baus et al, 2012;Yi et al, 2013). (Maurer et al, 2011;Indramohan et al, 2017). O trato aerodigestivo superior é a unidade neuromuscular mais complexa do corpo humano por ser conduto tanto da respiração quanto da deglutição.…”