Abstract:This study reports on a cohort of infants with single ventricle physiology following the hybrid procedure and found the incidence of aspiration to be lower than previously reported. Improved clinical bedside evaluation guidelines are needed so that clinicians can predict more reliably which infants are at risk for aspiration following the hybrid procedure.
“…Systematic enteral feeding algorithms and home nutritional monitoring programs have F I G U R E 1 Flow chart of study population derived from NPC-QIC registry and feeding methods at discharge following S2P. 7,16 To our knowledge, this is the first multicenter study to examine feeding method at S2P discharge for this high-risk population, and define patient characteristics associated with feeding method during S2P hospitalization and discharge. 5,[13][14][15] Evidence-based protocols that encompass all phases of palliative surgery to guide decision making for introduction and advancement of oral feeding are not available.…”
Section: Discussionmentioning
confidence: 99%
“…Evidence‐based protocols that encompass all phases of palliative surgery to guide decision making for introduction and advancement of oral feeding are not available. Variability in practice exists among institutions regarding when to introduce oral intake, the type and timing of feeding method, when supplementation is needed, and timing and utility of comprehensive swallowing assessments [eg, videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES)] . To our knowledge, this is the first multicenter study to examine feeding method at S2P discharge for this high‐risk population, and define patient characteristics associated with feeding method during S2P hospitalization and discharge.…”
Background: Tube feedings are often needed to achieve the growth and nutrition goals associated with decreased morbidity and mortality in patients with single ventricle anatomy. Variability in feeding method through the interstage period has been previously described, however, comparable information following stage 2 palliation is lacking.Objectives: To identify types of feeding methods following stage 2 palliation and their influence on length of stay.
Design: Secondary analysis of the National Pediatric Cardiology Quality ImprovementCollaborative registry was performed on 932 patients. Demographic data, medical characteristics, postoperative complications, type of feeding method, and length of stay for stage 2 palliation were analyzed.Results: Type of feeding method remained relatively unchanged during hospitalization for stage 2 palliation. Gastrostomy tube fed only patients were the oldest at time of surgery (182.7 ± 57.7 days, P < .001) and had the lowest weight-for-age z scores at admission (−1.6 ± 1.4, P < .001). Oral + gastrostomy tube groups had the longest median bypass times (172.5 minutes, P = .001) and longest length of stay (median 12 days, P < .001). Multivariable modeling revealed that feeding by tube only (P < .001), oral + tube feeding (P ≤ .001), reintubation (P < .001), and prolonged intubation (P < .001) were associated with increased length of stay. Neither age (P = .156) nor weight-for-age z score at admission (P = .066) was predictive of length of stay.
Conclusions:Feeding methods established at admission for stage 2 palliation are not likely to change by discharge. Length of stay is more likely to be impacted by tube feeding and intubation history than age or weight-for-age z score at admission. Better understanding for selection of feeding methods and their impact on patient outcomes is needed to develop evidence-based guidelines to decrease variability in clinical practice patterns and provide appropriate counseling to caregivers.
“…Systematic enteral feeding algorithms and home nutritional monitoring programs have F I G U R E 1 Flow chart of study population derived from NPC-QIC registry and feeding methods at discharge following S2P. 7,16 To our knowledge, this is the first multicenter study to examine feeding method at S2P discharge for this high-risk population, and define patient characteristics associated with feeding method during S2P hospitalization and discharge. 5,[13][14][15] Evidence-based protocols that encompass all phases of palliative surgery to guide decision making for introduction and advancement of oral feeding are not available.…”
Section: Discussionmentioning
confidence: 99%
“…Evidence‐based protocols that encompass all phases of palliative surgery to guide decision making for introduction and advancement of oral feeding are not available. Variability in practice exists among institutions regarding when to introduce oral intake, the type and timing of feeding method, when supplementation is needed, and timing and utility of comprehensive swallowing assessments [eg, videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES)] . To our knowledge, this is the first multicenter study to examine feeding method at S2P discharge for this high‐risk population, and define patient characteristics associated with feeding method during S2P hospitalization and discharge.…”
Background: Tube feedings are often needed to achieve the growth and nutrition goals associated with decreased morbidity and mortality in patients with single ventricle anatomy. Variability in feeding method through the interstage period has been previously described, however, comparable information following stage 2 palliation is lacking.Objectives: To identify types of feeding methods following stage 2 palliation and their influence on length of stay.
Design: Secondary analysis of the National Pediatric Cardiology Quality ImprovementCollaborative registry was performed on 932 patients. Demographic data, medical characteristics, postoperative complications, type of feeding method, and length of stay for stage 2 palliation were analyzed.Results: Type of feeding method remained relatively unchanged during hospitalization for stage 2 palliation. Gastrostomy tube fed only patients were the oldest at time of surgery (182.7 ± 57.7 days, P < .001) and had the lowest weight-for-age z scores at admission (−1.6 ± 1.4, P < .001). Oral + gastrostomy tube groups had the longest median bypass times (172.5 minutes, P = .001) and longest length of stay (median 12 days, P < .001). Multivariable modeling revealed that feeding by tube only (P < .001), oral + tube feeding (P ≤ .001), reintubation (P < .001), and prolonged intubation (P < .001) were associated with increased length of stay. Neither age (P = .156) nor weight-for-age z score at admission (P = .066) was predictive of length of stay.
Conclusions:Feeding methods established at admission for stage 2 palliation are not likely to change by discharge. Length of stay is more likely to be impacted by tube feeding and intubation history than age or weight-for-age z score at admission. Better understanding for selection of feeding methods and their impact on patient outcomes is needed to develop evidence-based guidelines to decrease variability in clinical practice patterns and provide appropriate counseling to caregivers.
“…A maioria dos artigos não descreveu os instrumentos avaliativos (MALKAR; JADCHERLA, 2014;ARIFPUTERA et al, 2014;BASSI et al, 2014;MUKDAD et al, 2019;LUNDINE et al, 2018;KARSCH et al, 2017;CHAUDHR et al, 2017), porém dois mencionaram a Escala Em relação ao procedimento cirúrgico cardíaco executado e a intubação orotraqueal, a maioria dos artigos não descreveu detalhadamente sobre estas variáveis, pontuando que as intervenções aconteceram no pós-cirúrgico (YOKOTA et al, 2019;MIRANDA et al, 2019;KARSCH et al, 2017), um no pré-cirúrgico (ARIFPUTERA et al, 2014) e um pontuou que a cirurgia cardíaca foi devido a doença cardíaca congênita grave (MALKAR; JADCHERLA, 2014). Apenas dois artigos detalharam sobre os procedimentos cirúrgicos, um artigo relatou a técnica NORWOOD ou cirurgia/procedimento híbrido (LUNDINE et al, 2018) e outro sobre a substituição da válvula aórtica transcateter (Transcatheter Aortic Valve Replacement -TAVR) (MUKDAD et al, 2019).…”
Direitos para esta edição cedidos à Atena Editora pelos autores. Todo o conteúdo deste livro está licenciado sob uma Licença de Atribuição Creative Commons. Atribuição-Não-Comercial-NãoDerivativos 4.0 Internacional (CC BY-NC-ND 4.0).O conteúdo dos artigos e seus dados em sua forma, correção e confiabilidade são de responsabilidade exclusiva dos autores, inclusive não representam necessariamente a posição oficial da Atena Editora. Permitido o download da obra e o compartilhamento desde que sejam atribuídos créditos aos autores, mas sem a possibilidade de alterá-la de nenhuma forma ou utilizá-la para fins comerciais. Todos os manuscritos foram previamente submetidos à avaliação cega pelos pares, membros do Conselho Editorial desta Editora, tendo sido aprovados para a publicação com base em critérios de neutralidade e imparcialidade acadêmica.A Atena Editora é comprometida em garantir a integridade editorial em todas as etapas do processo de publicação, evitando plágio, dados ou resultados fraudulentos e impedindo que interesses financeiros comprometam os padrões éticos da publicação. Situações suspeitas de má conduta científica serão investigadas sob o mais alto padrão de rigor acadêmico e ético.
“…No entanto, as doenças cardiovasculares podem se manifestar em qualquer faixa etária e apresentar sintomas e sinais como: sopro, cianose, diminuição no ganho de peso, fadiga, sudorese, taquicardia, cardiomegalia, anormalidade nos valores da pressão arterial, alteração de pulso, infecções pulmonares de repetição, dor torácica, síncopes, dificuldade para se alimentar, entre outras (LUNDINE et al, 2018).…”
Section: Introductionunclassified
“…Pacientes com disfagia podem apresentar retardamento na ingestão oral, aumento da utilização de tubos de alimentação e complicações cardiovasculares, incluindo arritmias, baixo débito cardíaco e necessidade de suporte inotrópico e mecânico (LUNDINE et al, 2018).…”
Direitos para esta edição cedidos à Atena Editora pelos autores. Todo o conteúdo deste livro está licenciado sob uma Licença de Atribuição Creative Commons. Atribuição-Não-Comercial-NãoDerivativos 4.0 Internacional (CC BY-NC-ND 4.0).O conteúdo dos artigos e seus dados em sua forma, correção e confiabilidade são de responsabilidade exclusiva dos autores, inclusive não representam necessariamente a posição oficial da Atena Editora. Permitido o download da obra e o compartilhamento desde que sejam atribuídos créditos aos autores, mas sem a possibilidade de alterá-la de nenhuma forma ou utilizá-la para fins comerciais. Todos os manuscritos foram previamente submetidos à avaliação cega pelos pares, membros do Conselho Editorial desta Editora, tendo sido aprovados para a publicação com base em critérios de neutralidade e imparcialidade acadêmica.A Atena Editora é comprometida em garantir a integridade editorial em todas as etapas do processo de publicação, evitando plágio, dados ou resultados fraudulentos e impedindo que interesses financeiros comprometam os padrões éticos da publicação. Situações suspeitas de má conduta científica serão investigadas sob o mais alto padrão de rigor acadêmico e ético.
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