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Published on: July 18, 2014
Cardiovascular intensive care unit variables inform need for feeding tube utilization in infants with hypoplastic
Caitlin Milligan1, Kimberly I Mills2, Shirley Ge1
1Department of Cardiology, Boston Children's Hospital, Boston, Mass.
Insights
Infants with hypoplastic left heart syndrome (HLHS) needing feeding tubes after stage 1 palliation can be identified early. Abnormal head imaging, ventilation duration, and vocal cord dysfunction predict feeding tube use.
Area of Science:
- Pediatric Cardiology
- Neonatal Care
- Clinical Risk Prediction
Background:
- Feeding tube utilization (FTU) is common in infants with hypoplastic left heart syndrome (HLHS) post-stage 1 palliation (S1P).
- Early identification of infants likely to require FTU can reduce morbidity.
- A predictive model for FTU is needed to guide clinical management.
Purpose of the Study:
- To develop a novel clinical risk prediction score for feeding tube utilization (FTU) in infants with HLHS following S1P.
Main Methods:
- Retrospective study of 180 HLHS infants undergoing S1P (2009-2019).
- Comparison of infants discharged with feeding tubes versus full oral feeds.
- Analysis of early, mid, and late hospitalization variables using univariate and multivariable models.
Main Results:
- 36.7% of infants were discharged with a feeding tube.
- Abnormal head imaging, ventilation duration, and vocal cord dysfunction were independent predictors of FTU in the mid-hospitalization model (c-statistic 0.87).
- A risk score (HV2 score) developed from these variables demonstrated high specificity (93%) for predicting FTU.
Conclusions:
- Abnormal head imaging, ventilation duration, and vocal cord dysfunction are key predictors of FTU in HLHS infants post-S1P.
- The HV2 risk score supports routine perioperative head imaging and vocal cord evaluation.
- The HV2 score has the potential to improve nutritional outcomes and reduce hospital length of stay.
Objective:
Feeding strategies in infants with hypoplastic left heart syndrome (HLHS) following stage 1 palliation (S1P) include feeding tube utilization (FTU). Timely identification of infants who will fail oral feeding could mitigate morbidity in this vulnerable population. We aimed to develop a novel clinical risk prediction score for FTU.
Methods:
This was a retrospective study of infants with HLHS admitted to the Boston Children's Hospital cardiovascular intensive care unit for S1P from 2009 to 2019. Infants discharged with feeding tubes were compared with those on full oral feeds. Variables from early (birth to surgery), mid (postsurgery to cardiovascular intensive care unit transfer), and late (inpatient transfer to discharge) hospitalization were analyzed in univariate and multivariable models.
Results:
Of 180 infants, 66 (36.7%) discharged with a feeding tube. In univariate analyses, presence of a genetic disorder (early variable, odds ratio, 3.25; P = .014) and nearly all mid and late variables were associated with FTU. In the mid multivariable model, abnormal head imaging, ventilation duration, and vocal cord dysfunction were independent predictors of FTU (c-statistic 0.87). Addition of late variables minimally improved the model (c-statistic 0.91). A risk score (the HV2 score) for FTU was developed based on the mid multivariable model with high specificity (93%).
Conclusions:
Abnormal head imaging, duration of ventilation, and presence of vocal cord dysfunction were associated with FTU in infants with HLHS following S1P. The predictive HV2 risk score supports routine perioperative head imaging and vocal cord evaluation. Future application of the HV2 score may improve nutritional morbidity and hospital length of stay in this population.
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