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- Title
Perioperative feeding management of neonates with CHD: analysis of the Pediatric Cardiac Critical Care Consortium (PC4) registry.
- Authors
Alten, Jeffrey A.; Rhodes, Leslie A.; Tabbutt, Sarah; Cooper, David S.; Graham, Eric M.; Ghanayem, Nancy; Marino, Bradley S.; Figueroa, Mayte I.; Chanani, Nikhil K.; Jacobs, Jeffrey P.; Donohue, Janet E.; Sunkyung Yu; Gaies, Michael; Yu, Sunkyung
- Abstract
<bold>Unlabelled: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
PERIOPERATIVE care; CONGENITAL heart disease in children; INFANT nutrition; NEONATAL diseases; PERINATAL care; CONGENITAL heart disease; AORTIC coarctation; ARTIFICIAL feeding; COMPARATIVE studies; ENTERAL feeding; NEONATAL necrotizing enterocolitis; GESTATIONAL age; CARDIAC surgery; LENGTH of stay in hospitals; PREMATURE infants; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; TRANSPOSITION of great vessels; EVALUATION research; ACQUISITION of data; HYPOPLASTIC left heart syndrome; SURGERY
- Publication
Cardiology in the Young, 2015, Vol 25, Issue 8, p1593
- ISSN
1047-9511
- Publication type
journal article
- DOI
10.1017/S1047951115002474