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Thickened feeds for infants with critical CHD: a survey of current practices
Courtney E Jones1, Hema Desai2, Susan Willette3
1Department of Acute Care Therapy Services, Primary Children's Hospital, Salt Lake City, UT, USA.
Insights
Thickened liquids are commonly used for infant dysphagia in critical congenital heart disease (CHD) but carry risks. This survey reveals frequent use in specialized centers, though treatment benefits and barriers require further research.
Area of Science:
- Pediatric Cardiology
- Speech-Language Pathology
- Clinical Nutrition
Background:
- Dysphagia is prevalent in infants with critical congenital heart disease (CHD).
- Thickened liquids are a common intervention, but associated risks limit their use.
- This study investigates dysphagia treatment practices and thickened liquid use in pediatric cardiac surgical centers.
Purpose of the Study:
- To assess current dysphagia treatment patterns in infants with critical CHD.
- To evaluate the utilization of thickened liquids across pediatric cardiac surgical centers.
- To identify barriers and variations in thickened liquid recommendations.
Main Methods:
- A 24-question, cross-sectional survey was distributed to 52 pediatric cardiac surgical centers.
- Convenience and snowball sampling methods were employed.
- Descriptive statistics were used to analyze survey responses.
Main Results:
- Twenty-six speech-language pathologists from 21 centers responded.
- 93% of centers use thickened liquids for dysphagia, often after instrumental assessment.
- Barriers include cost, parental adherence, and gastrointestinal concerns; use differs for single-ventricle vs. two-ventricle patients.
Conclusions:
- This is the first multi-institutional survey on dysphagia treatment variation in US congenital cardiac surgical centers.
- Thickened oral feedings are frequently used in high-risk critical CHD patients, but evidence of benefit is lacking.
- Further research is needed to address practice variations, treatment impacts, and barriers to thickening agent use.
Introduction:
Dysphagia is common in infants born with critical CHD. Thickened liquids are often used to treat dysphagia, but associated risks limit widespread use among feeding specialists. This survey aims to assess dysphagia treatment patterns and thickened liquid use across paediatric cardiac surgical centres.
Methods:
A 24-question, cross-sectional survey. Convenience and snowball sampling methods were used to engage 52 paediatric cardiac surgical centres affiliated with the Cardiac Newborn Neuroprotective Network. Descriptive statistics were used to analyse and compare responses.
Results:
Twenty-six individual respondents represented 21 unique paediatric cardiac surgical centres. Most responses were from experienced, speech-language pathologists (78%) at medium size centres (88%). Ninety-three percent of responding centres used thickened liquids to treat dysphagia and 81% only after formal instrumental assessment of swallowing. Thickened oral feeding was used for single-ventricle patients by 85% versus 69% for two-ventricle patients. Barriers to recommending thickened oral feedings included the cost of thickening agents, parental non-adherence, and gastrointestinal concerns.
Conclusions:
This is the first survey to report multi-institutional dysphagia treatment practice variation at United States congenital cardiac surgical centres. Thickened oral feedings are frequently used across centres in high-risk critical CHD patients but treatment benefit remains unclear. This survey highlights a broad scientific community poised to direct dysphagia research in critical CHD to address practice variation, short- and long-term impact of thickened oral feeding on feeding outcomes, and barriers to use and access of thickening agents.
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