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Postoperative feeding problems in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals undergoing unifocalisation surgery

Published online by Cambridge University Press:  02 August 2018

Andrew M. Koth Open the ORCID record for Andrew M. Koth [Opens in a new window] ,
Charlotte Sakarovitch ,
Douglas R. Sidell ,
Lisa M. Schultz ,
Allison Freccero ,
Sandra Rizzuto ,
Frank L. Hanley  and
Ritu Asija
Andrew M. Koth*
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Charlotte Sakarovitch
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Douglas R. Sidell
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Lisa M. Schultz
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Allison Freccero
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Sandra Rizzuto
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Frank L. Hanley
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
Ritu Asija
Affiliation:
Stanford Hospital and Clinics, Pediatric Cardiology, Stanford, CA, USA
*
Author for correspondence: A. M. Koth, MD, Division of Pediatric Cardiology, 750 Welch Road, Suite # 325, Palo Alto, CA 94304, USA. Tel: +206 794 4501; Fax: +650 724 4922; E-mail: akoth@stanford.edu
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Abstract

Background

Patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals are at risk for prolonged hospitalisation after unifocalisation. Feeding problems after congenital heart surgery are associated with longer hospital stay. We sought to determine the impact of baseline, intra-operative, and postoperative factors on the need for feeding tube use at the time of discharge.

Methods

We included patients with the aforementioned diagnosis undergoing unifocalisation from ages 3 months to 4 years from 2010 to 2016. We excluded patients with a pre-existing feeding tube. Patients discharged with an enteric tube were included in the feeding tube group. We compared the feeding tube group with the non-feeding-tube group by univariable and multi-variable logistic regression.

Results

Of the 56 patients studied, 41% used tube feeding. Median age and weight z-score were similar in the two groups. A chromosome 22q11 deletion was associated with the need for a feeding tube (22q11 deletion in 39% versus 15%, p=0.05). Median cardiopulmonary bypass time in the feeding tube group was longer (335 versus 244 minutes, p=0.04). Prolonged duration of mechanical ventilation was associated with feeding tube use (48 versus 3%, p=0.001). On multi-variable analysis, prolonged mechanical ventilation was associated with feeding tube use (odds ratio 10.2, 95% confidence intervals 1.6; 63.8).

Conclusion

Among patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals who were feeding by mouth before surgery, prolonged mechanical ventilation after unifocalisation surgery was associated with feeding tube use at discharge. Anticipation of feeding problems in this population and earlier feeding tube placement may reduce hospital length of stay.

Keywords

Unifocalisationpostoperative feedingtetalogy of Fallotpulmonary atresiaintensive care
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1329 - 1332
Copyright
© Cambridge University Press 2018 

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