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Perioperative feeding management of neonates with CHD: analysis of the Pediatric Cardiac Critical Care Consortium (PC4) registry

Published online by Cambridge University Press:  16 December 2015

Jeffrey A. Alten ,
Leslie A. Rhodes ,
Sarah Tabbutt ,
David S. Cooper ,
Eric M. Graham ,
Nancy Ghanayem ,
Bradley S. Marino ,
Mayte I. Figueroa ,
Nikhil K. Chanani  and
Jeffrey P. Jacobs
...Show all authors
Jeffrey A. Alten*
Affiliation:
Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
Leslie A. Rhodes
Affiliation:
Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
Sarah Tabbutt
Affiliation:
Department of Pediatrics, Benioff Children’s Hospital and University of California San Francisco School of Medicine, San Francisco, California, United States of America
David S. Cooper
Affiliation:
The Heart Institute Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Eric M. Graham
Affiliation:
Department of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Nancy Ghanayem
Affiliation:
Department of Pediatrics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
Bradley S. Marino
Affiliation:
Department of Pediatric Cardiology and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Evanston, Illinois, United States of America
Mayte I. Figueroa
Affiliation:
Department of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
Nikhil K. Chanani
Affiliation:
Department of Pediatric Cardiology, Emory University School of Medicine/Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Jeffrey P. Jacobs
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, St Petersburg, Tampa, Orlando, Florida, United States of America Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Janet E. Donohue
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Sunkyung Yu
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Michael Gaies
Affiliation:
Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, Michigan, United States of America
*
Correspondence to: J. A. Alten, MD, Department of Pediatrics, Pediatric Cardiac Intensive Care, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 9100, Birmingham, AL 35233, United States of America. Tel: +205 975 3123; Fax: +205 996 2359; E-mail: jalten@peds.uab.edu
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Abstract

Introduction

The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort.

Methods

Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry.

Results

The cohort included 251 patients from eight centres. The most common diagnoses included the following: hypoplastic left heart syndrome (17%), coarctation/aortic arch hypoplasia (18%), and transposition of the great arteries (22%); 14% of the patients were <37weeks of gestational age. The median total hospital length of stay was 21 days (interquartile range (IQR) 14–35) and overall mortality was 8%. Preoperative feeding occurred in 133 (53%) patients. The overall preoperative feeding rates across centres ranged from 29 to 79%. Postoperative feeds started on median day 2 (IQR 1–4); for patients with hypoplastic left heart syndrome postoperative feeds started on median day 4. Postoperative feeds were initiated in 89 (35%) patients before extubation (range across centres: 21–61%). The median cardiac ICU discharge feeding volume was 108 cc/kg/day, varying across centres. The mean discharge weight was 280 g above birth weight, ranging from +100 to 430 g across centres. A total of 110 (44%) patients had discharge feeding tubes, ranging from 6 to 80% across centres, and 40/110 patients had gastrostomy/enterostomy tubes placed. In addition, eight (3.2%) patients developed necrotising enterocolitis – three preoperatively and five postoperatively.

Conclusion

In this cohort, neonatal feeding practices and outcomes appear to vary across diagnostic groups and institutions. Only half of the patients received preoperative enteral nutrition; almost half had discharge feeding tubes. Multi-institutional collaboration is necessary to determine feeding strategies associated with best clinical outcomes.

Keywords

Neonatenutritioncardiovascular ICUfeedingcardiovascular surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 8: HeartWeek 2015 , December 2015 , pp. 1593 - 1601
Copyright
© Cambridge University Press 2015 

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