Management of oral feeding in children undergoing airway reconstruction

To systematically evaluate perioperative management of oral feeding in children undergoing airway reconstruction.

A retrospective chart review of all patients who underwent open airway reconstruction from February 1, 2006 through July 31, 2008 at a tertiary care children's hospital.

During the study period, a multidisciplinary protocol for perioperative management of alimentation was instituted. Swallowing function was evaluated pre- and postoperatively as part of a clinical management protocol.

Fifty-one patients underwent 55 reconstructions. Forty-eight of the patients (94%) have been decannulated. Eighteen single-stage procedures were performed on patients who were considered oral feeders, and oral feeding was successfully completed for three patients while the endotracheal tube was in place. Twenty-two double-stage procedures were performed on patients who were considered oral feeders. Oral feeding was initiated while the stent was in place for 16 patients. Nine patients (56%) did not tolerate oral feeding with the stent in place, five of whom had evidence of gross aspiration. Thirty-four of the 40 patients (85%) who were considered oral feeders at the time of their reconstruction returned to their preoperative diet with minimal therapy from the speech pathology service 1.9 days (range, 0-8 days) following extubation or stent removal. Six patients (15%) had clinically significant dysphagia.

Safe oral alimentation early in the postoperative period is possible with a rigorous multidisciplinary approach. To minimize complications, postoperative oral feeding should be initiated in conjunction with a speech pathologist.