Related Experiment Video
Updated: Dec 7, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
The Relationship Between Preoperative Feeding Exposures and Postoperative Outcomes in Infants With Congenital Heart
Jasmeet Kataria-Hale1,2,3,4,5, Acacia Cognata1,2,4, Joseph Hagan1,2,3,4,5
1Department of Pediatrics, Texas Children's Hospital, Houston, TX.
Insights
Infants with complex congenital heart disease and ductal-dependent systemic blood flow had longer hospital stays but not increased necrotizing enterocolitis risk. Nasogastric feeding also prolonged hospital stay without increasing this complication.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Critical Care Medicine
Background:
- Complex congenital heart disease (CCHD) in infants presents significant postoperative challenges.
- Understanding preoperative risk factors is crucial for optimizing outcomes in these vulnerable patients.
- Necrotizing enterocolitis (NEC) is a serious complication in neonates undergoing cardiac surgery.
Purpose of the Study:
- To investigate the association between preoperative risk factors and postoperative outcomes in infants with CCHD.
- To identify specific cardiac lesions and feeding strategies that impact length of stay, time to full feeds, and NEC occurrence.
- To inform perioperative management strategies for infants with CCHD.
Main Methods:
- Retrospective cohort study of 399 infants with CCHD born between 2010 and 2016.
- Analysis of preoperative factors including feeding type, route, and cardiac lesion characteristics.
- Evaluation of postoperative outcomes such as NEC, hospital length of stay, and days to achieve full feeds.
Main Results:
- The incidence of postoperative necrotizing enterocolitis was 8%; no significant association was found with preoperative feeding or cardiac lesion type.
- Cardiac lesions with ductal-dependent systemic blood flow were linked to significantly longer hospital stays and delayed full feeds compared to ductal-dependent pulmonary blood flow.
- Preoperative nasogastric feeding was associated with increased length of stay and time to full feeds, but not with a higher risk of NEC.
Conclusions:
- While certain cardiac lesions and feeding routes impact resource utilization, they do not elevate the risk of postoperative necrotizing enterocolitis.
- Findings suggest that current perioperative management strategies may not be cost-effective, necessitating re-evaluation.
- Further research into optimizing feeding protocols and managing high-risk cardiac lesions is warranted to improve efficiency and patient outcomes.
Objectives:
To evaluate the association of preoperative risk factors and postoperative outcomes in infants with complex congenital heart disease.
Design:
Single-center retrospective cohort study.
Setting:
Neonatal ICU and cardiovascular ICU.
Patients:
Infants of all gestational ages, born at Texas Children's Hospital between 2010 and 2016, with complex congenital heart disease requiring intervention prior to discharge.
Interventions:
None.
Measurements And Main Results:
A total of 399 patients were enrolled in the study. Preoperative risk factors included feeding, type of feeding, feeding route, and cardiac lesion. Postoperative outcomes included necrotizing enterocolitis, hospital length of stay, and days to full feeds. The occurrence rate of postoperative necrotizing enterocolitis (all stages) was 8%. Preoperative feeding, type of feeding, feeding route, and cardiac lesion were not associated with higher odds of postoperative necrotizing enterocolitis. Cardiac lesions with ductal-dependent systemic blood flow were associated with a hospital length of stay of 19.6 days longer than those with ductal-dependent pulmonary blood flow (p < 0.001) and 2.9 days longer to reach full feeds than those with ductal-dependent pulmonary blood flow (p < 0.001), after controlling for prematurity. Nasogastric feeding route preoperatively was associated with a length of stay of 29.8 days longer than those fed by mouth (p < 0.001) and 2.4 days longer to achieve full feeds (p < 0.001), after controlling for prematurity and cardiac lesion. Preoperative diet itself was not associated with significant change in length of stay or days to reach full feeds.
Conclusions:
Although cardiac lesions with ductal-dependent systemic blood flow are considered high risk and may increase length of stay and days to achieve full feeds, they are not associated with a higher risk of postoperative necrotizing enterocolitis. Nasogastric route is not associated with a significantly higher risk of necrotizing enterocolitis, but longer length of stay and days to reach full feeds. These findings challenge our perioperative management strategies in caring for these infants, as they may incur more hospital costs and resources without significant medical benefit.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...