Enteral Feeding Methods in Patients with Vocal Fold Motion Impairment Following Cardiothoracic Surgery

Vocal fold motion impairment in children with congenital heart disease occurs at the time of cardiothoracic, surgical aortic arch manipulation due to injury of the recurrent laryngeal nerve. We conducted a single-center retrospective analysis of pediatric patients (≤ 18 years old) diagnosed with vocal fold motion impairment post-cardiothoracic surgery between 2021 and 2023. Patients were categorized by the presence or absence of vocal fold motion impairment and then subdivided into pre- or post-pyloric enteral feed groups. Of the 61 patients eligible for inclusion, 32 were diagnosed with vocal fold motion impairment. Infants with vocal fold motion impairment had a longer length of stay (35 [18, 199.5] versus 22 [9, 39] days, p = 0.03), more complex surgeries/aortic arch augmentation (75% versus 41%, p = 0.02), and were fed more by nasoduodenal route (31% versus 7%, p = 0.02). Patients who were fed via the nasoduodenal route compared to those fed via the pre-pyloric route were more likely to have longer cardiopulmonary bypass times (188 [147, 251] versus 93 [76, 100] min, p = 0.01), single ventricle palliation (60% versus 18%, p = 0.037) and longer length of stay (138 [44, 255] versus 24.5 [16, 60] days, p = 0.02). There was no difference in aspiration events (p = 0.09), aspiration pneumonia (p = 1.0), or readmission rates (within 30 days, p = 0.22) between the groups. Pre-pyloric feeding methods in patients with vocal fold motion impairment had no more adverse events of aspiration post-operatively.