Cardiology in the Young

Original Articles

Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery

Sharon Sables-Bausa1, Jon Kaufmana2, Paul Cooka3 and Eduardo M. da Cruza4 c1

a1 Department of Pediatrics, The College of Nursing, The Children's Hospital of Denver, School of Medicine, Denver, Colorado, United States of America

a2 Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, Denver, Colorado, United States of America

a3 Department of Pediatrics, Center for Nursing Research, University of Colorado at Denver, Denver, Colorado, United States of America

a4 Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, University of Colorado at Denver, Denver, Colorado, United States of America

Abstract

Background Achievement of adequate oral nutrition is a challenging task after early neonatal cardiac surgery. This study aims to describe predictors of oral feeding outcomes for neonates after early surgical interventions.

Materials and methods A retrospective review of neonates admitted with congenital cardiac disease over a period of 1 year. We analysed predictors of the need for a feeding tube at discharge and the amount taken at each feeding. Multilevel modelling was used to look at individual change over time predicting oral amount at each feeding.

Results We identified 56 neonates. Diagnoses were heterogeneous; 23% of the infants had associated genetic syndromes and 45% required pre-operative mechanical ventilation. The median time from birth to surgery was 8.4 days, with 29 infants fed orally before surgery. The mean time from surgery to first oral feeding attempt was 12 hours. Time from surgery to oral feeding, the amount taken with first feeding, and cross-clamp times were significant predictors of oral feeding success, whereas the presence of a comorbidity – genetic abnormality – and longer ventilator dependency predicted failure. Almost half of the neonates required a feeding tube upon discharge, and no infant discharged was solely breastfed. Discharge with a feeding tube was associated with greater weight gain at that time.

Conclusions Neonates with congenital cardiac disease face significant barriers to successfully achieving oral feeding on hospital discharge. Enteral feeding guidelines focus on physiological stabilisation and do not always address the developmental milestones necessary to support oral feeding. Future prospective studies are necessary to identify multimodal strategies to optimise early feeding.

(Received January 06 2011)

(Accepted May 12 2011)

(Online publication July 04 2011)

Correspondence:

c1 Correspondence to: Dr E. M. da Cruz, MD, Head, Pediatric Cardiac Critical Care Program, Professor of Pediatrics, Department of Pediatrics, The Heart Institute, The Children's Hospital of Denver, School of Medicine, University of Colorado at Denver, 13120 East 16th Avenue, B-100, Aurora, Colorado 80045, United States of America. Tel: +1 720 777 4055; Fax: +1 720 777 7290; E-mail: dacruz.eduardo@tchden.org