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

Published online by Cambridge University Press:  19 July 2011

Lisa W. Howley ,
Jon Kaufman ,
Erica Wymore ,
Patti Thureen ,
Jeff K. Magouirk ,
Bryan McNair  and
Eduardo M. da Cruz
Lisa W. Howley
Affiliation:
Section of Pediatric Cardiac Intensive Care, The Heart Institute, University of Colorado at Denver, Aurora, Colorado, United States of America
Jon Kaufman
Affiliation:
Section of Pediatric Cardiac Intensive Care, The Heart Institute, University of Colorado at Denver, Aurora, Colorado, United States of America
Erica Wymore
Affiliation:
Division of Neonatology, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America
Patti Thureen
Affiliation:
Division of Neonatology, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America
Jeff K. Magouirk
Affiliation:
Department of Pediatrics, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America
Bryan McNair
Affiliation:
Research Institute, University of Colorado at Denver, Aurora, Colorado, United States of America
Eduardo M. da Cruz*
Affiliation:
Section of Pediatric Cardiac Intensive Care, The Heart Institute, University of Colorado at Denver, Aurora, Colorado, United States of America
*
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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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.

Keywords

Prostaglandincongenital cardiac diseasefeedingductus arteriosusnecrotising enterocolitis
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 2 , 02 March 2012 , pp. 121 - 127
Copyright
Copyright © Cambridge University Press 2011

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References

1.Willis, L, Thureen, P, Kaufman, J, Wymore, E, Skillman, H, da Cruz, E. Enteral feeding in prostaglandin-dependent neonates: is it a safe practice? J Pediatr 2008; 153: 867–869.CrossRefGoogle ScholarPubMed
2.Natarajan, G, Reddy Anne, S, Aggarwal, S. Enteral feeding of neonates with congenital heart disease. Neonatology 2010; 98: 330–336.CrossRefGoogle ScholarPubMed
3.del Castillo, SL, McCulley, ME, Khemani, RG, et al. Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med 2010; 11: 373–377.Google ScholarPubMed
4.Luce, WA, Schwartz, RM, Beauseau, W, et al. Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease. Pediatr Crit Care Med 2011; 12: 46–51.CrossRefGoogle ScholarPubMed
5.Leung, M, Chau, K, Hui, P, et al. Necrotizing enterocolitis in neonates with symptomatic congenital heart disease. J Pediatr 1988; 113: 1044–1046.CrossRefGoogle ScholarPubMed
6.Hebra, A, Brown, MF, Hirschl, RB, et al. Mesenteric ischemia in hypoplastic left heart syndrome. J Pediatr Surg 1998; 33: 647–649.Google Scholar
7.McElhinney, D, Hedrick, H, Bush, D, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.Google Scholar
8.Palder, S, Schwartz, M, Tyson, K, Marr, C. Association of closure of patent ductus arteriosus and development of necrotizing enterocolitis. J Pediatr Surg 1988; 23: 422–423.CrossRefGoogle ScholarPubMed
9.Coombs, RC, Morgan, ME, Durbin, GM, Booth, IW, McNeish, AS. Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and parenteral indomethacin. Arch Dis Child 1990; 65: 1067–1071.Google Scholar
10.Martinussen, M, Brubakk, A, Vik, T, Yao, AC. Mesenteric blood flow velocity and its relation to transitional circulatory adaptation in appropriate for gestational age preterm infants. Pediatr Res 1996; 39: 275–280.CrossRefGoogle ScholarPubMed
11.Tiffany, K, Burke, B, Collins-Odoms, C, Oelberg, D. Current practice regarding the enteral feeding of high-risk newborns with umbilical catheters in situ. Pediatrics 2003; 112: 20–23.CrossRefGoogle ScholarPubMed
12.Havranek, T, Johanboeke, P, Madramootoo, C, Carver, JD. Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings. J Perinatol 2007; 27: 375–379.CrossRefGoogle Scholar
13.Davey, A, Wagner, C, Cox, C, Kendig, J. Feeding premature infants while low umbilical artery catheters are in place: A prospective, randomized trial. J Pediatr 1994; 124: 795–799.CrossRefGoogle ScholarPubMed
14.Darst, JR, Newburger, JW, Resch, S, Rathod, RH, Lock, JE. Deciding without data. Congenit Heart Dis 2010; 5: 339–342.Google Scholar
15.Rathod, RH, Farias, M, Friedman, KG, et al. A novel approach to gathering and acting on relevant clinical information: SCAMPs. Congenit Heart Dis 2010; 5: 343–353.CrossRefGoogle ScholarPubMed