The Relationship Between Preoperative Feeding Exposures and Postoperative Outcomes in Infants With Congenital Heart Disease

Abstract

Objectives: To evaluate the association of preoperative risk factors and postoperative outcomes in infants with complex congenital heart disease. Design: Single-center retrospective cohort study. Setting: Neonatal ICU and cardiovascular ICU. Patients: Infants of all gestational ages, born at Texas Children’s Hospital between 2010 and 2016, with complex congenital heart disease requiring intervention prior to discharge. Interventions: None. Measurements and Main Results: A total of 399 patients were enrolled in the study. Preoperative risk factors included feeding, type of feeding, feeding route, and cardiac lesion. Postoperative outcomes included necrotizing enterocolitis, hospital length of stay, and days to full feeds. The occurrence rate of postoperative necrotizing enterocolitis (all stages) was 8%. Preoperative feeding, type of feeding, feeding route, and cardiac lesion were not associated with higher odds of postoperative necrotizing enterocolitis. Cardiac lesions with ductal-dependent systemic blood flow were associated with a hospital length of stay of 19.6 days longer than those with ductal-dependent pulmonary blood flow (p < 0.001) and 2.9 days longer to reach full feeds than those with ductal-dependent pulmonary blood flow (p < 0.001), after controlling for prematurity. Nasogastric feeding route preoperatively was associated with a length of stay of 29.8 days longer than those fed by mouth (p < 0.001) and 2.4 days longer to achieve full feeds (p < 0.001), after controlling for prematurity and cardiac lesion. Preoperative diet itself was not associated with significant change in length of stay or days to reach full feeds. Conclusions: Although cardiac lesions with ductal-dependent systemic blood flow are considered high risk and may increase length of stay and days to achieve full feeds, they are not associated with a higher risk of postoperative necrotizing enterocolitis. Nasogastric route is not associated with a significantly higher risk of necrotizing enterocolitis, but longer length of stay and days to reach full feeds. These findings challenge our perioperative management strategies in caring for these infants, as they may incur more hospital costs and resources without significant medical benefit.

Oral Aversion in Infants With Congenital Heart Disease: A Single-Center Retrospective Cohort Study*

“…Characterizing the incidence and prevalence of OA in children with congenital heart disease is difficult due to the lack of a standardized diagnosis, limits on coding in the International Classification of Diseases, and imprecise terminology (4,17). While limited studies describe surgical and preoperative factors associated with prolonged transition to oral feeds during the surgical hospitalization (18)(19)(20), data on longer-term feeding outcomes, including OA, are scarce, with much of the literature focusing on growth and weight gain (21)(22)(23). Neonates who require cardiac surgery spend their early life in the cardiac ICU (CICU), yet little is known about risk factors for development of OA during this critical developmental period, thus obscuring potential modifiable practices to reduce the frequency of OA.…”

Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review

“…For these reasons, clinicians may have concerns about initiating and increasing feeds in CHD patients, leading to frequent interruption or delay, which may itself be deleterious [ 25 ]. Prolonged periods of fasting result in intestinal villus atrophy as well as intestinal microbiota impairment with loss of barrier function, which may increase the risk for NEC and negatively affect growth [ 22 , 35 , 36 ].…”

“…However, the current lack of standardized protocols in the preoperative enteral nutrition management of infants with CHD leads to clinician variability on when, with what and how to feed. This potentially exposes new-born infants to negative post-operative outcomes such as NEC, poor growth and increased length of hospital stay [ 35 ].…”

Oral feeding dysfunction in post-operative infants with CHDs: a scoping review

“…Of the 25 references included in the final narrative synthesis, study designs were as follows: 20 cohort studies 7,14,15,17,[19][20][21]23,[25][26][27][28][29][31][32][33][34][35][36][37] , 2 cross-sectional studies 18,30 , 1 quasi-experimental with nonequivalent group design 16 , 1 case-control study 22 , and 1 nonrandomised control trial. 24 Data collection methods were retrospective chart review (n = 17) 7,14,15,17,20,22,[25][26][27]29,[31][32][33][34][35][36][37] or prospective enrolment (n = 7). 17,18,21,23,24,28,30 In one intervention study…”