Management of oral feeding in children undergoing airway reconstruction.
OBJECTIVE
To systematically evaluate perioperative management of oral feeding in children undergoing airway reconstruction.


METHODS
A retrospective chart review of all patients who underwent open airway reconstruction from February 1, 2006 through July 31, 2008 at a tertiary care children's hospital.


METHODS
During the study period, a multidisciplinary protocol for perioperative management of alimentation was instituted. Swallowing function was evaluated pre- and postoperatively as part of a clinical management protocol.


RESULTS
Fifty-one patients underwent 55 reconstructions. Forty-eight of the patients (94%) have been decannulated. Eighteen single-stage procedures were performed on patients who were considered oral feeders, and oral feeding was successfully completed for three patients while the endotracheal tube was in place. Twenty-two double-stage procedures were performed on patients who were considered oral feeders. Oral feeding was initiated while the stent was in place for 16 patients. Nine patients (56%) did not tolerate oral feeding with the stent in place, five of whom had evidence of gross aspiration. Thirty-four of the 40 patients (85%) who were considered oral feeders at the time of their reconstruction returned to their preoperative diet with minimal therapy from the speech pathology service 1.9 days (range, 0-8 days) following extubation or stent removal. Six patients (15%) had clinically significant dysphagia.


CONCLUSIONS
Safe oral alimentation early in the postoperative period is possible with a rigorous multidisciplinary approach. To minimize complications, postoperative oral feeding should be initiated in conjunction with a speech pathologist.
Smith
Lee P
LP
Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Otto
Staci E
SE
Wagner
Kathrine A
KA
Chewaproug
Linda
L
Jacobs
Ian N
IN
Zur
Karen B
KB
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D019651:Plastic Surgery Procedures; D015619:Respiratory System Abnormalities / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D014139:Tracheostomy; D016896:Treatment Outcome