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The prevalence and effects of aspiration among neonates at the time of discharge

  • Emily Karsch (a1), Sharon Y. Irving (a1) (a2), Brandon S. Aylward (a3) and William T. Mahle (a3)



Neonates undergoing heart surgery for CHD are at risk for postoperative gastrointestinal complications and aspiration events. There are limited data regarding the prevalence of aspiration after neonatal cardiothoracic surgery; thus, the effects of aspiration events on this patient population are not well understood. This retrospective chart review examined the prevalence and effects of aspiration among neonates who had undergone cardiac surgery at the time of their discharge.


This study examined the prevalence of aspiration among neonates who had undergone cardiac surgery. Demographic data regarding these patients were analysed in order to determine risk factors for postoperative aspiration. Post-discharge feeding routes and therapeutic interventions were extracted to examine the time spent using alternate feeding routes because of aspiration risk or poor caloric intake. Modified barium swallow study results were used to evaluate the effectiveness of the test as a diagnostic tool.

Materials and methods

A retrospective study was undertaken of neonates who had undergone heart surgery from July, 2013 to January, 2014. Data describing patient demographics, feeding methods, and follow-up visits were recorded and compared using a χ2 test for goodness of fit and a Kaplan–Meier graph.


The patient population included 62 infants – 36 of whom were male, and 10 who were born with single-ventricle circulation. The median age at surgery was 6 days (interquartile range=4 to 10 days). Modified barium swallow study results showed that 46% of patients (n=29) aspirated or were at risk for aspiration, as indicated by laryngeal penetration. In addition, 48% (n=10) of subjects with a negative barium swallow or no swallow study demonstrated clinical aspiration events. Tube feedings were required by 66% (n=41) of the participants. The median time spent on tube feeds, whether in combination with oral feeds or exclusive use of a nasogastric or gastric tube, was 54 days; 44% (n=27) of patients received tube feedings for more than 120 days. Premature infants were significantly more likely to have aspiration events than infants delivered at full gestational age (OR p=0.002). Infants with single-ventricle circulation spent a longer time on tube feeds (median=95 days) than infants with two-ventricle defects (median=44 days); the type of cardiac defect was independent of prevalence of an aspiration event.


Aspiration is common following neonatal cardiac surgery. The modified barium swallow study is often used to identify aspiration events and to determine an infant’s risk for aspirating. This leads to a high proportion of infants who require tube feedings following neonatal cardiac surgery.


Corresponding author

Correspondence to: W. T. Mahle, MD, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322-1062, United States of America. Tel: +404 785 1672; Fax: 404 785 6021; E-mail:


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1. Davies, RR, Carver, SW, Schmidt, R, et al. Gastrointestinal complications after stage I Norwood versus hybrid procedures. Ann Thorac Surg 2013; 95: 189195.
2. Kakodkar, K, Schroeder, JW. Pediatric dysphagia. Pediatr Clin North Am 2013; 60: 969977.
3. St. Pierre, A, Khattra, P, Johnson, M, et al. Content validation of the infant malnutrition and feeding checklist for congenital heart disease: a tool to identify risk of malnutrition and feeding difficulties in infants with congenital heart disease. J Pediatr Nurs 2010; 25: 367374.
4. Aviv, JE. Prospective randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope 2000; 110: 563574.
5. Skinner, ML, Halstead, LA, Rubenstein, CS, et al. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 12931301.
6. Kohr, LM, Dargan, M, Hague, A, et al. The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography. Soc Thorac Surg 2003; 76: 14501456.
7. Medoff-Cooper, B, Irving, SY. Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19 (Suppl 2): 9095.
8. Kovesi, T, Rubin, S. Long term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest J 2004; 126: 915925.
9. O’Connor, MJ, Ravishankar, C, Ballweg, JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg 2011; 142: 106112.
10. Torowicz, DL, Seelhorst, A, Froh, EB, et al. Human milk and breastfeeding outcomes in infants with congenital heart disease. Breastfeed Med 2015; 10: 3137.
11. Newman, LA, Keckley, C, Peterson, MC, et al. Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatrics 2001; 108: e106.
12. Bazyk, S. Factors associated with the transition to oral feeding in infants fed by nasogastric tubes. Am J Occup Ther 1990; 44: 10701078.
13. Aviv, JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope 2000; 110: 563574.
14. Brady, S, Donzelli, J. Modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am 2013; 46: 10091022.
15. Genna, CW, Sandora, L. Breastfeeding: normal sucking and swallowing. In: Genna CW, (ed.) Supporting Sucking Skills in Breastfeeding Infants. Jones and Bartlett Learning, Burlington, MA, 2013: 148.
16. Sachdeva, R, Hussain, E, Moss, MM, et al. Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr 2007; 151: 312315; .e1–2.
17. Agnew, NM, Kendall, JB, Akrofi, M, et al. Gastroesophageal reflux and tracheal aspiration in the thoracotomy position: should ranitidine premedication be routine? Anesth Analg 2002; 95: 16451649.
18. Ferraris, VA, Ferraris, SP, Moritz, DM, Welch, S. Oropharyngeal dysphagia after cardiac operations. Ann Thorac Surg 2001; 71: 17921795.
19. Starks, B, Harbert, C. Aspiration prevention protocol: decreasing postoperative pneumonia in heart surgery patients. Crit Care Nurse 2011; 31: 3845.
20. Medoff-Cooper, B, Irving, SY, Mariano, BS, et al. Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge. Cardiol Young 2011; 21: 136144.
21. Pasquali, SK, Ohye, RG, Lu, M, et al. Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 2012; 144: 915921.
22. Jadcherla, S. Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr 2016; 103: 62256285.


The prevalence and effects of aspiration among neonates at the time of discharge

  • Emily Karsch (a1), Sharon Y. Irving (a1) (a2), Brandon S. Aylward (a3) and William T. Mahle (a3)


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