Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-14T00:46:12.588Z Has data issue: false hasContentIssue false

Perioperative feeding management of neonates with CHD: analysis of the Pediatric Cardiac Critical Care Consortium (PC4) registry

Published online by Cambridge University Press:  16 December 2015

Jeffrey A. Alten*
Affiliation:
Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
Leslie A. Rhodes
Affiliation:
Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
Sarah Tabbutt
Affiliation:
Department of Pediatrics, Benioff Children’s Hospital and University of California San Francisco School of Medicine, San Francisco, California, United States of America
David S. Cooper
Affiliation:
The Heart Institute Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Eric M. Graham
Affiliation:
Department of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Nancy Ghanayem
Affiliation:
Department of Pediatrics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
Bradley S. Marino
Affiliation:
Department of Pediatric Cardiology and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Evanston, Illinois, United States of America
Mayte I. Figueroa
Affiliation:
Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Nikhil K. Chanani
Affiliation:
Department of Pediatric Cardiology, Emory University School of Medicine/Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Jeffrey P. Jacobs
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, St Petersburg, Tampa, Orlando, Florida, United States of America Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Janet E. Donohue
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Sunkyung Yu
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Michael Gaies
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
*
Correspondence to: J. A. Alten, MD, Department of Pediatrics, Pediatric Cardiac Intensive Care, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 9100, Birmingham, AL 35233, United States of America. Tel: +205 975 3123; Fax: +205 996 2359; E-mail: jalten@peds.uab.edu

Abstract

Introduction

The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort.

Methods

Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry.

Results

The cohort included 251 patients from eight centres. The most common diagnoses included the following: hypoplastic left heart syndrome (17%), coarctation/aortic arch hypoplasia (18%), and transposition of the great arteries (22%); 14% of the patients were <37weeks of gestational age. The median total hospital length of stay was 21 days (interquartile range (IQR) 14–35) and overall mortality was 8%. Preoperative feeding occurred in 133 (53%) patients. The overall preoperative feeding rates across centres ranged from 29 to 79%. Postoperative feeds started on median day 2 (IQR 1–4); for patients with hypoplastic left heart syndrome postoperative feeds started on median day 4. Postoperative feeds were initiated in 89 (35%) patients before extubation (range across centres: 21–61%). The median cardiac ICU discharge feeding volume was 108 cc/kg/day, varying across centres. The mean discharge weight was 280 g above birth weight, ranging from +100 to 430 g across centres. A total of 110 (44%) patients had discharge feeding tubes, ranging from 6 to 80% across centres, and 40/110 patients had gastrostomy/enterostomy tubes placed. In addition, eight (3.2%) patients developed necrotising enterocolitis – three preoperatively and five postoperatively.

Conclusion

In this cohort, neonatal feeding practices and outcomes appear to vary across diagnostic groups and institutions. Only half of the patients received preoperative enteral nutrition; almost half had discharge feeding tubes. Multi-institutional collaboration is necessary to determine feeding strategies associated with best clinical outcomes.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Owens, JL, Musa, N. Nutritional support after neonatal cardiac surgery. Nutr Clin Pract 2009; 24: 242249.CrossRefGoogle ScholarPubMed
2.Medoff-Cooper, B, Irving, S, Bird, G, et al. Growth and nutrition status of infants after stage 1 reconstruction. Acta Paediatr 2009; 98: 186187.Google Scholar
3.Kelleher, DK, Laussen, P, Teixeira-Pinto, A, Duggan, C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237244.CrossRefGoogle ScholarPubMed
4.Skinner, ML, Halstead, LA, Rubinstein, CS, Atz, AM, Andrews, D, Bradley, SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 12931301.CrossRefGoogle ScholarPubMed
5.Ravishankar, C, Zak, V, Williams, IA, et al. Association of impaired linear growth and worse neurodevelopmental outcome in infants with single ventricle physiology; a report from the paediatric heart network infant single ventricle trial. J Pediatr 2013; 162: 250256.e2.CrossRefGoogle ScholarPubMed
6.Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495501.CrossRefGoogle ScholarPubMed
7.Pasquali, SK, Ohye, RG, Lu, M, et al. Variation in perioperative car across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 2012; 144: 915921.CrossRefGoogle Scholar
8.Lambert, LM, Pike, NA, Medoff-Cooper, B, et al. Variation in feeding practices following the Norwood procedure. J Pediatr 2014; 164: 237242.e1.CrossRefGoogle ScholarPubMed
9.Petit, CJ, Fraser, CD, Mattamal, R, Slesnick, TC, Cephus, CE, Ocampo, EC. The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage nutrition, and 1-year survival. J Thorac Cardiovasc Surg 2011; 142: 13581366.CrossRefGoogle Scholar
10.Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome postage 1 palliation. Pediatr Crit Care Med 2009; 10: 460466.CrossRefGoogle Scholar
11.del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373377.Google ScholarPubMed
12.Ghanayem, NS, Hoffman, GM, Mussatto, KA, et al. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 2003; 126: 13671377.CrossRefGoogle ScholarPubMed
13.Toms, R, Kirklin, JK, Dabal, RJ, Reebals, CH, Alten, JA. Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 2014; 10: 553559.Google ScholarPubMed
14.Iannucci, GJ, Oster, ME, Mahle, WT. Necrotizing enterocolitis in infants with congenital heart disease: the role of enteral feeds. Cardiol Young 2013; 23: 553559.CrossRefGoogle ScholarPubMed
15.Willis, L, Thureen, P, Kaufman, J, Wymore, E, Skillman, H, da Cruz, E. Enteral feeding in prostaglandin-dependent neonates: is it a safe practice? J Pediatr 2008; 153: 867869.CrossRefGoogle ScholarPubMed
16.Becker, KC, Hornik, CP, Cotton, CM, et al. Necrotizing enterocolitis in infants with ductal-dependent congenital heart disease. Am J Perinatol 2015; 32: 633638.CrossRefGoogle ScholarPubMed
17.Gaies, M, Donohue, JE, Willis, GM, et al. Data integrity of the paediatric cardiac critical care consortium (PC4) clinical registry: results of the 1st year data audit. Cardiol Young 2015; (Epub ahead of print).Google Scholar
18.O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.CrossRefGoogle ScholarPubMed
19.Franklin, RC, Jacobs, JP, Krogmann, ON, et al. Nomenclature for congenital and paediatric cardiac disease: historical perspectives and The International Paediatric and Congenital Cardiac Code. Cardiol Young 2008; 18 (Suppl 2): 7080.CrossRefGoogle Scholar
20.McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Paediatrics 2000; 106: 10801087.CrossRefGoogle ScholarPubMed
21.Cameron, JW, Rosenthal, A, Olson, AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med 1995; 149: 10981102.CrossRefGoogle ScholarPubMed
22.Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Ped Crit Care Med 2015; 16: 448452.CrossRefGoogle ScholarPubMed
23.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: 152160.CrossRefGoogle ScholarPubMed
24.Anderson, JB, Beekman, RH, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397404.e1.CrossRefGoogle ScholarPubMed
25.Natarajan, G, Reddy, AS, Aggarwal, S. Enteral feeding of neonates with congenital heart disease. Neonatology 2013; 8: 234239.Google Scholar
26.Lehmiller, DJ, Kanot, WP. Relationships of mesenteric thromboembolism, oral feeding, and necrotizing enterocolitis. J Pediatr 1978; 92: 96100.CrossRefGoogle ScholarPubMed
27.Howely, LW, Kaufman, J, Wymore, E, et al. Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice. Cardiol Young 2012; 22: 121127.CrossRefGoogle Scholar
28.Davies, RR, Carver, SW, Schmidt, R, et al. Gastrointestinal complications after stage I Norwood versus hybrid procedures. Ann Thorac Surg 2013; 95: 189195; discussion 195–196.CrossRefGoogle Scholar
29.Jeffries, HE, Wells, WJ, Starnes, VA, Wetzel, RC, Moromisato, DY. Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2006; 81: 982987.CrossRefGoogle ScholarPubMed
30.Yang, S, Wu, X, Yu, W, Li, J. Early enteral nutrition in critically ill patients with haemodynamic instability: an evidence-based review and practical advice. Nutr Clin Pract 2014; 29: 9096.CrossRefGoogle ScholarPubMed