Feeding difficulty in newborns following congenital heart surgery

Following neonatal congenital heart surgery, one of the factors impacting patient recovery is feeding difficulty. The aim of this study is to identify the risk factors.

Patients who underwent surgery for congenital heart defects within the first 15 days of life were reviewed. Endpoints for feeding difficulty included: (1) a prolonged time to reach goal feeds; (2) a prolonged transition to oral feeds requiring tube feeds at discharge; and (3) additional procedures to facilitate feeding. Preoperative, operative, and postoperative data were examined to identify risk factors for feeding difficulty.

A total of 83 records were reviewed and showed the following feeding difficulties: 9 patients (10.8%) had a prolonged time to reach goal feeds, 37 (44.6%) had a prolonged time to transition to oral feeds, and 8 (9.6%) required subsequent procedures to facilitate feeding. Significant risk factors for all endpoints included an increased risk adjusted congenital heart surgery (RACHS) score and prolonged intubation. Significant risk factors for individual endpoints included return to the intensive care unit with an open chest for endpoint 1, and a single functional ventricle and the presence of a shunt for endpoint 3. The remaining factors (gestational age, weight at the time of surgery, being intubated at the time of surgery, underlying disease, utilization and time of cardiopulmonary bypass, utilization of trans-esophageal echocardiography, and surgical proximity to the aortic arch) had no significant effect on postoperative feeding.

Feeding difficulties are not uncommon following surgery for the correction of congenital heart defects, especially in the neonate. The most important risk factors appear to be an increased RACHS score and prolonged postoperative intubation. Hopefully, by defining the risk factors, proactive management strategies can be developed to minimize these problems following neonatal congenital heart surgery.