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Gastrostomy Tube Feeding after Neonatal Complex Cardiac Surgery Identifies the Need for Early Developmental
M Florencia Ricci1, Gwen Y Alton2, David B Ross3
1Division of Developmental Pediatrics, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Insights
Gastrostomy tube feeding (GTF) in complex cardiac surgery (CCS) survivors is linked to higher rates of developmental delay. Nonmodifiable factors like chromosomal abnormalities and single ventricle anatomy predict GTF need, guiding early intervention for at-risk children.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Neonatal Surgery
Background:
- Early complex cardiac surgery (CCS) survivors face risks for developmental delay.
- Gastrostomy tube feeding (GTF) is sometimes required for nutritional support in these vulnerable infants.
- Identifying predictors of GTF can help anticipate and manage potential developmental challenges.
Purpose of the Study:
- To compare developmental delay rates in CCS survivors with and without GTF.
- To identify acute care predictors associated with the need for GTF in CCS survivors.
- To inform early intervention strategies for high-risk CCS survivors.
Main Methods:
- A cohort of 334 CCS survivors (≤6 weeks of age) were assessed at 21 months using standardized developmental and adaptive behavior scales.
- Developmental delay was defined as scores more than 2 standard deviations below the mean.
- Logistic regression analysis identified predictors of GTF, with results expressed as odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- 20% of CCS survivors required GTF before 21 months.
- Children with GTF showed significantly higher rates of cognitive (24% vs 3%), motor (27% vs 3%), and language (36% vs 12%) delays (P < .001).
- Chromosomal abnormality (OR 4.6), single ventricle anatomy (OR 3.4), prolonged sternal opening (OR 1.15), and extended hospital stay (OR 1.03) independently predicted GTF.
Conclusions:
- GTF in CCS survivors is a marker for increased risk of developmental delay.
- Early developmental intervention is crucial for CCS survivors identified as needing GTF.
- Nonmodifiable predictors of GTF can aid in family counseling and risk stratification.
Objective:
To compare the proportion of developmental delay in early complex cardiac surgery (CCS) survivors with and without gastrostomy tube feeding (GTF). To explore acute care predictors of GTF that might help improve care in CCS survivors.
Study Group:
This comparison study of 2 groups within an inception cohort included 334 CCS survivors after cardiopulmonary bypass at ≤6 weeks of age (2005-2012) who did not require extracorporeal membrane oxygenation or heart transplantation. Children were assessed at 21 ± 3 months with the Bayley Scales of Infant and Toddler Development-Third Edition and the Adaptive Behavior Assessment System-Second Edition: general adaptive composite score. Delay was determined by scores >2 SD below mean. The χ(2) test compared groups. Predictors of GTF were analyzed using multiple logistic regression analysis, results expressed as OR with 95% CI.
Results:
Of the survivors, 67/334 (20%) had GTF any time before the 21-month assessment. Developmental delays in children with GTF were cognitive in 16 (24%), motor in 18 (27%), language in 24 (36%) vs without GTF in 7 (3%), 8 (3%), and 32 (12%), respectively (P < .001). Gastrostomy group had almost 8 times the number of children delayed on the general adaptive composite score. Independent OR for GTF are presence of a chromosomal abnormality, OR 4.6 (95% CI 1.8, 12.0) (P = .002), single ventricle anatomy, OR 3.4 (95% CI 1.7, 6.8) (P < .001), total postoperative days of open sternum, OR 1.15 (95% CI 1.1, 1.3) (P = .031), and total number of hospital days at CCS, OR 1.03 (95% CI 1.1, 1.04) (P = .002).
Conclusions:
GTF identifies CCS survivors at risk for delay, who would benefit from early developmental intervention. The described mostly nonmodifiable predictors may guide counseling of these children's families.
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