title: Preoperative trophic feeds in neonates with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  The aim of this is study is to determine if preoperative trophic feeds (TFs) can improve outcomes after Norwood palliation.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  The setting is a pediatric cardiovascular intensive care unit in a tertiary hospital.
  
  
  METHODS
  The patients were 50 consecutive patients with hypoplastic left heart, excluding 5 patients with prematurity or other significant comorbidities. Thirty-one patients that received preoperative TFs (20-30 mL/kg) were compared with 14 that remained nothing by mouth. Decision to initiate feeds was based on attending preference. All patients had protocolized feeds postoperatively, with initiation via transpyloric tube when patient was on minimal inotropes.
  
  
  METHODS
  Demographic, feeding, and other clinical outcome data were collected retrospectively from the patient medical record.
  
  
  RESULTS
  There were no differences in demographics or preoperative risk factors (mechanical ventilation and lowest pH) between the two groups. Overall survival to discharge was 78% (25/31 TF, 10/14 nothing by mouth, P = .7). Neonates receiving TFs had less fluid administration in the cardiovascular operating room (P = .002), a more negative 48-hour postoperative fluid balance (P = .03), and median 3 days shorter duration of mechanical ventilation (P = .006). Trophic feeds patients also had a nonsignificant trend toward lower peak lactic acid (P = .06), lower inotropic score (P = .15), shorter hospital length of stay (P = .19), and faster time to tolerance of full enteral and oral feeds by 3 and 8 days, respectively (P = .06 and .01). There were no episodes of necrotizing enterocolitis in either group.
  
  
  CONCLUSIONS
  Preoperative TFs before Norwood palliation appear safe and are associated with shorter duration of mechanical ventilation, a trend toward more stable postoperative hemodynamics, less fluid overload, and earlier postoperative feeding tolerance.
authors.affiliation: Department of Pediatrics, Division of Critical Care, Section of Cardiovascular Intensive Care, University of Alabama at Birmingham, Birmingham, Ala, USA; Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Ala, USA.
authors.forename: Rune
authors.initials: R
authors.lastname: Toms
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Jackson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dabal
authors.forename: Cristina H
authors.initials: CH
authors.lastname: Reebals
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alten
mesh_terms: D000407:Alabama; D004750:Enteral Nutrition / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D041943:Infant Formula; D007226:Infant Mortality; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008895:Milk, Human; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality; D009752:Nutritional Status; D010166:Palliative Care; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D010351:Patient Discharge; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011300:Preoperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Congenital Heart Disease; Hypoplastic Left Heart Syndrome; Necrotizing Enterocolitis; Neonates; Trophic Feeds