Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2025-01-05T23:39:43.841Z Has data issue: false hasContentIssue false
  • English
  • Français

Feeding difficulties in neonates following cardiac surgery: determinants of prolonged feeding-tube use

Published online by Cambridge University Press:  23 January 2017

Elissa B. McKean ,
Nadine A. Kasparian ,
Shweta Batra ,
Gary F. Sholler ,
David S. Winlaw  and
Jacqueline Dalby-Payne
Elissa B. McKean
Affiliation:
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia Department of General Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
Nadine A. Kasparian
Affiliation:
Heart Centre for Children, The Sydney Children’s Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia Discipline of Paediatrics, School of Women’s and Children’s Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
Shweta Batra
Affiliation:
Department of General Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
Gary F. Sholler
Affiliation:
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia Heart Centre for Children, The Sydney Children’s Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia
David S. Winlaw
Affiliation:
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia Heart Centre for Children, The Sydney Children’s Hospitals Network (Westmead and Randwick), Sydney, New South Wales, Australia
Jacqueline Dalby-Payne*
Affiliation:
Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia Department of General Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
*
Correspondence to: J. Dalby-Payne, Department of General Medicine, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Tel: +61 2 9845 0000; Fax: +61 2 9845 0074; E-mail: jacqueline.dalbypayne@health.nsw.gov.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

The aims of this study were to examine the prevalence and potential correlates of feeding difficulties in infants who underwent cardiac surgery in the neonatal period and to investigate resource utilisation by infants with feeding difficulties.

Methods

All neonates who underwent their first cardiac surgery at the Heart Centre for Children, The Children’s Hospital at Westmead, between January and December, 2009 were included. Demographic, preoperative, intraoperative, and postoperative data were collected via electronic medical records. For the purpose of this study, feeding difficulty was defined as the requirement for ongoing tube feeding at the time of discharge home or transfer to another hospital.

Results

Out of a total of 79 neonates, 24 (30%) were discharged home or transferred to another hospital with a feeding tube. Feeding difficulties were associated with the presence of a genetic syndrome (p<0.0001), assisted feeding preoperatively (odds ratio (OR)=4.4, p=0.03), and having a palliative procedure before biventricular repair (OR=5.1, p=0.02). Infants with feeding difficulties had significantly more reviews by speech pathologists (M=5.9, SD=7.9), dieticians (M=5.9, SD=5.4), and cardiac clinical nurse consultants (M=1.2, SD=1.4) compared with those without feeding difficulties.

Conclusions

This study identified factors that can be used in the early recognition of infant feeding difficulties, to help guide the direction of limited health resources, as well as being focal points for future research and clinical practice improvement.

Keywords

CHDcardiac surgeryfeedingneonatehealth services
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1203 - 1211
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Einarson, KD, Arthur, HM. Predictors of oral feeding difficulty in cardiac surgical infants. Pediatr Nurs 2003; 29: 315–319.Google ScholarPubMed
2. Sables-Baus, S, Kaufman, J, Cook, P, da Cruz, EM. Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery. Cardiol Young 2012; 22: 42–48.Google Scholar
3. Kogon, BE, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2007; 2: 332–337.Google Scholar
4. Medoff-Cooper, B, Irving, SY. Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19 (Suppl 2): 90–95.Google Scholar
5. Steltzer, M, Rudd, N, Pick, B. Nutrition care for newborns with congenital heart disease. Clin Perinatol 2005; 32: 1017–1030; xi.Google Scholar
6. Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328–333.CrossRefGoogle ScholarPubMed
7. Jadcherla, SR, Vijayapal, AS, Leuthner, S. Feeding abilities in neonates with congenital heart disease: a retrospective study. J Perinatol 2009; 29: 112–118.CrossRefGoogle ScholarPubMed
8. Gaynor, JW. The encephalopathy of congenital heart disease. J Thorac Cardiovasc Surg 2014; 148: 1790–1791.Google Scholar
9. Maurer, I, Latal, B, Geissmann, H, Knirsch, W, Bauersfeld, U, Balmer, C. Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease. Cardiol Young 2011; 21: 303–309.CrossRefGoogle ScholarPubMed
10. Hill, GD, Silverman, AH, Noel, RJ, et al. Feeding dysfunction in children with single ventricle following staged palliation. J Pediatr 2014; 164: 243–6.e1.CrossRefGoogle ScholarPubMed
11. Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA). Canberra, Australia, 2008.Google Scholar
12. Hosmer, DW LS. Applied Logistic Regression. Wiley and Sons: Toronto, ON; 2000.CrossRefGoogle Scholar
13. Kleinbaum, D KL, Muller, K. Applied Regression Analysis and Other Multivariate Methods. PWS-KENT: Boston, MA; 1987.Google Scholar
14. Medoff-Cooper, B, Ravishankar, C. Nutrition and growth in congenital heart disease: a challenge in children. Curr Opin Cardiol 2013; 28: 122–129.Google Scholar
15. Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495–501.Google Scholar
16. Cooper-Brown, L, Copeland, S, Dailey, S, et al. Feeding and swallowing dysfunction in genetic syndromes. Dev Disabil Res Rev 2008; 14: 147–157.Google Scholar
17. Pickler, RH, Best, A, Crosson, D. The effect of feeding experience on clinical outcomes in preterm infants. J Perinatol 2009; 29: 124–129.Google Scholar
18. Howley, LW, Kaufman, J, Wymore, E, et al. Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice. Cardiol Young 2012; 22: 121–127.CrossRefGoogle ScholarPubMed
19. Natarajan, G, Reddy Anne, S, Aggarwal, S. Enteral feeding of neonates with congenital heart disease. Neonatology 2010; 98: 330–336.Google Scholar
20. 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.Google Scholar
21. Slicker, J, Hehir, DA, Horsley, M, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis 2013; 8: 89–102.Google Scholar
22. Kaufman, J, Vichayavilas, P, Rannie, M, et al. Improved nutrition delivery and nutrition status in critically ill children with heart disease. Pediatrics 2015; 135: e717–e725.Google Scholar
23. Hehir, DA, Rudd, N, Slicker, J, et al. Normal interstage growth after the Norwood operation associated with interstage home monitoring. Pediatr Cardiol 2012; 33: 1315–1322.Google Scholar
24. Srinivasan, C, Sachdeva, R, Morrow, WR, et al. Standardized management improves outcomes after the Norwood procedure. Congenit Heart Dis 2009; 4: 329–337.Google Scholar
25. Garcia, X, Jaquiss, RD, Imamura, M, Swearingen, CJ, Dassinger, MS 3rd, Sachdeva, R. Preemptive gastrostomy tube placement after Norwood operation. J Pediatr 2011; 159: 602–7.e1.Google Scholar
26. Hebson, CL, Oster, ME, Kirshbom, PM, Clabby, ML, Wulkan, ML, Simsic, JM. Association of feeding modality with interstage mortality after single-ventricle palliation. J Thorac Cardiovasc Surg 2012; 144: 173–177.CrossRefGoogle ScholarPubMed
27. Uzark, K, Wang, Y, Rudd, N, et al. Interstage feeding and weight gain in infants following the Norwood operation: can we change the outcome? Cardiol Young 2012; 22: 520–527.CrossRefGoogle ScholarPubMed
28. Hofner, G, Behrens, R, Koch, A, Singer, H, Hofbeck, M. Enteral nutritional support by percutaneous endoscopic gastrostomy in children with congenital heart disease. Pediatr Cardiol 2000; 21: 341–346.Google Scholar
29. Srinivasan, R, O’Neill, C, Blumenow, W, Dalzell, AM. Perceptions of caregivers following percutaneous endoscopic gastrostomy in children with congenitally malformed hearts. Cardiol Young 2009; 19: 507–510.CrossRefGoogle ScholarPubMed
30. Benzecry, SG, Leite, HP, Oliveira, FC, Santana, EMJF, de Carvalho, WB, Silva, CM. Interdisciplinary approach improves nutritional status of children with heart diseases. Nutrition 2008; 24: 669–674.Google Scholar
31. Kasparian, NA, Winlaw, DS, Sholler, GF. “Congenital heart health”: how psychological care can make a difference. Med J Aust 2016; 205: 104–107.CrossRefGoogle Scholar
32. Svavarsdottir, EK, McCubbin, M. Parenthood transition for parents of an infant diagnosed with a congenital heart condition. J Pediatr Nurs 1996; 11: 207–216.Google Scholar
33. Blue, GM, Kasparian, NA, Sholler, GF, Kirk, EP, Winlaw, DS. Genetic counselling in parents of children with congenital heart disease significantly improves knowledge about causation and enhances psychosocial functioning. Int J Cardiol 2015; 178: 124–130.Google Scholar
34. Kasparian, NA, Fidock, B, Sholler, GF, et al. Parents’ perceptions of genetics services for congenital heart disease: the role of demographic, clinical, and psychological factors in determining service attendance. Genet Med 2014; 16: 460–468.Google Scholar
35. Tregay, J, Brown, K, Crowe, S, Bull, C, Knowles, R, Wray, J. “I was so worried about every drop of milk” – feeding problems at home are a significant concern for parents after major heart surgery in infancy. Matern Child Nutr 2016, doi:10.1111/mcn.12302.Google Scholar
36. Hartman, DM, Medoff-Cooper, B. Transition to home after neonatal surgery for congenital heart disease. MCN Am J Matern Child Nurs 2012; 37: 95–100.Google Scholar