Cardiology in the Young

Original Articles

Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice

Lisa W. Howleya1, Jon Kaufmana1, Erica Wymorea2, Patti Thureena2, Jeff K. Magouirka3, Bryan McNaira4 and Eduardo M. da Cruza1 c1

a1 Section of Pediatric Cardiac Intensive Care, The Heart Institute, University of Colorado at Denver, Aurora, Colorado, United States of America

a2 Division of Neonatology, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America

a3 Department of Pediatrics, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America

a4 Research Institute, University of Colorado at Denver, Aurora, Colorado, United States of America

Abstract

Background The benefits of early enteral feeding in neonates are well known and yet the optimal pre-operative nutrition of prostaglandin-dependent infants with congenital cardiac disease remains ill-defined. This survey delineates international nutritional practices and trends with this population.

Materials and methods Paediatric practitioners responded to an Internet-based survey that explored assessment of feeding practices, criteria for feeding readiness, medication dosing, concurrent feeding with umbilical catheters, and the observed incidence of feeding intolerance. Documented nutritional strategies were not correlated with patient outcomes.

Results A total of 200 caregivers responded to the survey. Fewer United States caregivers (56%) reported routine pre-operative enteral feeding in prostaglandin-dependent infants when compared with caregivers outside the United States of America (93%). Of those respondents willing to feed, approximately two-thirds did not base their decision on the ductal flow direction. Numerous and heterogeneous parameters were reported to assess feeding readiness. Many caregivers report scepticism with regard to enteral feeding safety in neonates with an umbilical artery catheter, and to a lesser extent in the presence of an umbilical venous catheter. In summary, there is a prevailing lack of consensus regarding pre-operative enteral nutrition to prostaglandin-dependent neonates.

Conclusions This survey demonstrates noticeable variations in pre-operative nutritional practices between providers from around the world. Arguments that support or refute this practice have little support in the medical literature. Future studies should aim to demonstrate the safety of such practice and compare the outcomes of prostaglandin-dependent neonates who were pre-operatively enterally fed with those who were not.

(Received January 07 2011)

(Accepted May 25 2011)

(Online publication July 19 2011)

Correspondence:

c1 Correspondence to: Dr E. M. da Cruz, MD, Head, Pediatric Cardiac Critical Care Program, Director, Cardiac Intensive Care Unit & Cardiac Progressive Care Unit, Professor of Pediatrics, The Children's Hospital, University of Colorado at Denver, School of Medicine, 13121 East 16th Avenue, B-100, Aurora, Colorado 80045, United States of America. Tel: +1 720 777 6992; Fax: +1 720 777 7290; E-mail: dacruz.eduardo@tchden.org

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