title: Gastrostomy Tube Feeding after Neonatal Complex Cardiac Surgery Identifies the Need for Early Developmental Intervention.
abstract: OBJECTIVE
  To compare the proportion of developmental delay in early complex cardiac surgery (CCS) survivors with and without gastrostomy tube feeding (GTF). To explore acute care predictors of GTF that might help improve care in CCS survivors.
  
  
  METHODS
  This comparison study of 2 groups within an inception cohort included 334 CCS survivors after cardiopulmonary bypass at ≤6 weeks of age (2005-2012) who did not require extracorporeal membrane oxygenation or heart transplantation. Children were assessed at 21 ± 3 months with the Bayley Scales of Infant and Toddler Development-Third Edition and the Adaptive Behavior Assessment System-Second Edition: general adaptive composite score. Delay was determined by scores >2 SD below mean. The χ(2) test compared groups. Predictors of GTF were analyzed using multiple logistic regression analysis, results expressed as OR with 95% CI.
  
  
  RESULTS
  Of the survivors, 67/334 (20%) had GTF any time before the 21-month assessment. Developmental delays in children with GTF were cognitive in 16 (24%), motor in 18 (27%), language in 24 (36%) vs without GTF in 7 (3%), 8 (3%), and 32 (12%), respectively (P < .001). Gastrostomy group had almost 8 times the number of children delayed on the general adaptive composite score. Independent OR for GTF are presence of a chromosomal abnormality, OR 4.6 (95% CI 1.8, 12.0) (P = .002), single ventricle anatomy, OR 3.4 (95% CI 1.7, 6.8) (P < .001), total postoperative days of open sternum, OR 1.15 (95% CI 1.1, 1.3) (P = .031), and total number of hospital days at CCS, OR 1.03 (95% CI 1.1, 1.04) (P = .002).
  
  
  CONCLUSIONS
  GTF identifies CCS survivors at risk for delay, who would benefit from early developmental intervention. The described mostly nonmodifiable predictors may guide counseling of these children's families.
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: M Florencia
authors.initials: MF
authors.lastname: Ricci
authors.affiliation: Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.
authors.forename: Gwen Y
authors.initials: GY
authors.lastname: Alton
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.affiliation: Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Dicken
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Moddemann
authors.affiliation: Division of Developmental Pediatrics, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Pediatric Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada. Electronic address: Charlene.Robertson@albertahealthservices.ca.
authors.forename: Charlene M T
authors.initials: CM
authors.lastname: Robertson
mesh_terms: D006348:Cardiac Surgical Procedures; D002658:Developmental Disabilities / Q000517:prevention & control*; D061345:Early Medical Intervention; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care; D011446:Prospective Studies