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

Jeffrey A. Alten*, Leslie A. Rhodes, Sarah Tabbutt, David S. Cooper, Eric M. Graham, Nancy Ghanayem, Bradley S. Marino, Mayte I. Figueroa, Nikhil K. Chanani, Jeffrey P. Jacobs, Janet E. Donohue, Sunkyung Yu, Michael Gaies

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

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 ≥ 3/424 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.

Original languageEnglish (US)
Pages (from-to)1593-1601
Number of pages9
JournalCardiology in the young
Volume25
Issue number8
DOIs
StatePublished - Dec 1 2015

Keywords

  • Neonate
  • cardiovascular ICU
  • cardiovascular surgery
  • feeding
  • nutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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