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Prevalence and Risk Factors for Tube-Feeding at Discharge in Infants following Early Congenital Heart Disease
Sreekanth Viswanathan1, Kaitlyn Jade F Ong1, Bahram Kakavand2
1Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida.
Insights
Oral feeding difficulty is common in infants after congenital heart disease surgery. Infants admitted at birth, with higher pre-surgery milk calories, and GERD are at higher risk for tube-feeding at discharge.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Gastroenterology
Background:
- Oral feeding difficulty is a frequent complication in infants post-congenital heart disease (CHD) surgery.
- This difficulty is linked to extended hospital stays and an increased likelihood of requiring tube-feeding (TF) upon discharge.
- Limited understanding exists regarding the enteropathogenesis of feeding issues in these infants.
Purpose of the Study:
- To determine the prevalence of tube-feeding (TF) at discharge in infants following CHD surgery.
- To identify significant risk factors associated with the need for TF in this population.
Main Methods:
- A retrospective cohort study was conducted over six years (2016-2021) at a single center.
- Infants under six months undergoing CHD surgery were analyzed.
- Infants requiring TF were compared to those achieving independent oral feeding (IOF).
Main Results:
- Out of 128 infants, 18.8% required TF at discharge.
- Multivariate analysis identified admission at birth, higher pre-surgery milk calories, and gastroesophageal reflux disease (GERD) as significant risk factors for TF.
- Infants requiring TF experienced significantly longer hospital stays and lower weight gain compared to those with IOF.
Conclusions:
- The prevalence of TF in this cohort is consistent with previous research.
- Key risk factors for TF include admission at birth, elevated pre-surgery milk caloric intake, and clinical GERD.
- Addressing these modifiable risk factors can improve infant outcomes and potentially reduce healthcare costs.
Objective:
Oral feeding difficulty is common in infants after congenital heart disease (CHD) surgical repair and is associated with prolonged hospital stay and increased risk for tube-feeding at discharge (TF). The current understanding of the enteropathogenesis of oral feeding difficulty in infants requiring CHD surgery is limited. To determine the prevalence and risk factors for TF following CHD surgery in early infancy.
Study Design:
This was a 6-year single-center retrospective cohort study (2016-2021) of infants under 6 months who had CHD surgery. Infants required TF were compared with infants who reached independent oral feeding (IOF).
Results:
Of the final sample of 128 infants, 24 (18.8%) infants required TF at discharge. The risk factors for TF in univariate analysis include low birth weight, low 5-minute Apgar score, admitted at birth, risk adjustment in congenital heart surgery categories IV to VI, presence of genetic diagnosis, use of Prostin, higher pre- and postsurgery respiratory support, lower weight at surgery, lower presurgery oral feeding, higher presurgery milk calory, delayed postsurgery enteral and oral feeding, higher pre- and postsurgery gastroesophageal reflux disease (GERD), need for swallow study, abnormal brain magnetic resonance imaging (p < 0.05). In the multivariate analysis, only admitted at birth, higher presurgery milk calories, and GERD were significant risk factors for TF. TF had significantly longer hospital stay (72 vs. 17 days) and lower weight gain at discharge (z-score: -3.59 vs. -1.94) compared with IOF (p < 0.05).
Conclusion:
The prevalence of TF at discharge in our study is comparable to previous studies. Infants with CHD admitted at birth, received higher presurgery milk calories, and clinical GERD are significant risk factors for TF. Mitigating the effects of identified risk factors for TF will have significant impact on the quality of life for these infants and their families and may reduce health care cost.
Key Points:
· Oral feeding difficulty in infants after congenital heart disease surgical repair is common.. · Such infants require prolonged hospital stay and higher risk for tube-feeding at discharge.. · Identifying modifiable risk factors associated with tube-feeding can enhance clinical outcomes..
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