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Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery

Published online by Cambridge University Press:  04 July 2011

Sharon Sables-Baus ,
Jon Kaufman ,
Paul Cook  and
Eduardo M. da Cruz
Sharon Sables-Baus
Affiliation:
Department of Pediatrics, The College of Nursing, The Children's Hospital of Denver, School of Medicine, Denver, Colorado, United States of America
Jon Kaufman
Affiliation:
Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, Denver, Colorado, United States of America
Paul Cook
Affiliation:
Department of Pediatrics, Center for Nursing Research, University of Colorado at Denver, Denver, Colorado, United States of America
Eduardo M. da Cruz*
Affiliation:
Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, University of Colorado at Denver, Denver, Colorado, United States of America
*
Correspondence to: Dr E. M. da Cruz, MD, Head, Pediatric Cardiac Critical Care Program, Professor of Pediatrics, Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, University of Colorado at Denver, 13120 East 16th Avenue, B-100, Aurora, Colorado 80045, United States of America. Tel: +1 720 777 4055; Fax: +1 720 777 7290; E-mail: [email protected]
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Abstract

Background

Achievement of adequate oral nutrition is a challenging task after early neonatal cardiac surgery. This study aims to describe predictors of oral feeding outcomes for neonates after early surgical interventions.

Materials and methods

A retrospective review of neonates admitted with congenital cardiac disease over a period of 1 year. We analysed predictors of the need for a feeding tube at discharge and the amount taken at each feeding. Multilevel modelling was used to look at individual change over time predicting oral amount at each feeding.

Results

We identified 56 neonates. Diagnoses were heterogeneous; 23% of the infants had associated genetic syndromes and 45% required pre-operative mechanical ventilation. The median time from birth to surgery was 8.4 days, with 29 infants fed orally before surgery. The mean time from surgery to first oral feeding attempt was 12 hours. Time from surgery to oral feeding, the amount taken with first feeding, and cross-clamp times were significant predictors of oral feeding success, whereas the presence of a comorbidity – genetic abnormality – and longer ventilator dependency predicted failure. Almost half of the neonates required a feeding tube upon discharge, and no infant discharged was solely breastfed. Discharge with a feeding tube was associated with greater weight gain at that time.

Conclusions

Neonates with congenital cardiac disease face significant barriers to successfully achieving oral feeding on hospital discharge. Enteral feeding guidelines focus on physiological stabilisation and do not always address the developmental milestones necessary to support oral feeding. Future prospective studies are necessary to identify multimodal strategies to optimise early feeding.

Keywords

Congenital cardiac diseaseoral feedinggrowth and nutritionoutcomescardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 42 - 48
Copyright
Copyright © Cambridge University Press 2011

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References

1. Gillespie, M, Kuijpers, M, Van Rossem, M, et al. Determinants of intensive care unit length of stay for infants undergoing cardiac surgery. Congenit Heart Dis 2006; 1: 152–160.CrossRefGoogle ScholarPubMed
2. McConnell, ME, Elixson, EM. The neonate with suspected congenital heart disease. Crit Care Nurs Q 2002; 25: 17–25.CrossRefGoogle ScholarPubMed
3. Walker, K, Holland, AJ, Winlaw, D, Sherwood, M, Badawi, N. Neurodevelopmental outcomes and surgery in neonates. J Paediatr Child Health 2006; 42: 749–751.CrossRefGoogle ScholarPubMed
4. Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328–333.CrossRefGoogle ScholarPubMed
5. Bellinger, DC, Wypij, D, duPlessis, AJ, et al. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 2003; 126: 1385–1396.CrossRefGoogle ScholarPubMed
6. Dittrich, H, Buhrer, C, Grimmer, I, et al. Neurodevelopment at 1 year of age in infants with congenital heart disease. Heart 2003; 89: 436–441.CrossRefGoogle ScholarPubMed
7. Fuller, S, Nord, AS, Gerdes, M, et al. Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery. Eur J Cardiothorac Surg 2009; 36: 40–47.CrossRefGoogle ScholarPubMed
8. Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Neurodevelopmental status of newborns and infants with congenital heart defects before and after open heart surgery. J Pediatr 2000; 137: 638–645.CrossRefGoogle ScholarPubMed
9. Massaro, AN, El-Dib, M, Glass, P, Aly, H. Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev 2008; 30: 437–446.CrossRefGoogle ScholarPubMed
10. Uzark, K, Lincoln, A, Lamberti, JJ, et al. Neurodevelopmental outcomes in children with Fontan repair of functional single ventricle. Pediatrics 1998; 101: 630–633.CrossRefGoogle ScholarPubMed
11. Medoff-Cooper, B, Irving, SY. Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19: 90–95.Google Scholar
12. Imms, C. Feeding the infant with congenital heart disease: an occupational performance challenge. Am J Occup Ther 2001; 55: 277–284.CrossRefGoogle ScholarPubMed
13. Mizuno, K, Ueda, A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Dev Med Child Neurol 2005; 47: 299–304.CrossRefGoogle ScholarPubMed
14. Tsai, SW, Chen, CH, Lin, MC. Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion. Pediatr Int 2010; 52: 65–68.CrossRefGoogle ScholarPubMed
15. Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460–466.CrossRefGoogle ScholarPubMed
16. Imms, C. Impact on parents of feeding young children with congenital or acquired cardiac disease. Cardiol Young 2000; 10: 574–581.CrossRefGoogle ScholarPubMed
17. Jadcherla, SR, Vijayapal, AS, Leuthner, S. Feeding abilities in neonates with congenital heart disease: a retrospective study. J Perinatol 2009; 29: 112–118.CrossRefGoogle ScholarPubMed
18. Kogon, BE, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2007; 2: 332–337.Google Scholar
19. Schmid, G, Schreier, A, Meyer, R, Wolke, D. A prospective study on the persistence of infant crying, sleeping and feeding problems and preschool behaviour. Acta Paediatr 2010; 99: 286–290.CrossRefGoogle ScholarPubMed
20. Bakewell-Sachs, S, Medoff-Cooper, B, Escobar, GJ, Silber, JH, Lorch, SA. Infant functional status: the timing of physiologic maturation of premature infants. Pediatrics 2009; 123: 878–886.CrossRefGoogle ScholarPubMed
21. Harrison, TM. Effect of maternal behavior on regulation during feeding in healthy infants and infants with transposition. J Obstet Gynecol Neonat Nurs 2009; 38: 504–513.CrossRefGoogle ScholarPubMed
22. Cleaveland, K. Feeding challenges in the late preterm infant. Neonatal Netw 2010; 29: 37–41.CrossRefGoogle ScholarPubMed
23. Darcy, AE. Complications of the late preterm infant. J Perinat Neonatal Nurs 2009; 23: 78–86.CrossRefGoogle ScholarPubMed
24. Walker, M. Breastfeeding the late preterm infant. J Obstet Gynecol Neonatal Nurs 2008; 37: 692–701.CrossRefGoogle ScholarPubMed
25. Barros, MC, Mitsuhiro, S, Chalem, E, Laranjeira, RR, Guinsburg, R. Neurobehavior of late preterm infants of adolescent mothers. Neonatology 2010; 99: 133–139.CrossRefGoogle ScholarPubMed