title: Perioperative feeding management of neonates with CHD: analysis of the Pediatric Cardiac Critical Care Consortium (PC4) registry.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1Department of Pediatric Cardiology,Section of Cardiac Critical Care Medicine,University of Alabama at Birmingham,Birmingham,Alabama,United States of America.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alten
authors.affiliation: 1Department of Pediatric Cardiology,Section of Cardiac Critical Care Medicine,University of Alabama at Birmingham,Birmingham,Alabama,United States of America.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Rhodes
authors.affiliation: 2Department of Pediatrics,Benioff Children's Hospital and University of California San Francisco School of Medicine,San Francisco,California,United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.affiliation: 3The Heart Institute Cincinnati Children's Hospital Medical Center,Cincinnati,Ohio,United States of America.
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.affiliation: 4Department of Pediatric Cardiology,Medical University of South Carolina,Charleston,South Carolina,United States of America.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Graham
authors.affiliation: 5Department of Pediatrics,Children's Hospital of Wisconsin,Medical College of Wisconsin,Milwaukee,Wisconsin,United States of America.
authors.forename: Nancy
authors.initials: N
authors.lastname: Ghanayem
authors.affiliation: 6Department 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.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.affiliation: 7Department of Pediatric Cardiology,University of Tennessee Health Science Center,Memphis,Tennessee,United States of America.
authors.forename: Mayte I
authors.initials: MI
authors.lastname: Figueroa
authors.affiliation: 8Department of Pediatric Cardiology,Emory University School of Medicine/Children's Healthcare of Atlanta,Atlanta,Georgia,United States of America.
authors.forename: Nikhil K
authors.initials: NK
authors.lastname: Chanani
authors.affiliation: 9Division 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.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: 11Division 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.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: 11Division 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.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: 11Division 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.
authors.forename: Michael
authors.initials: M
authors.lastname: Gaies
mesh_terms: D001017:Aortic Coarctation / Q000601:surgery; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005248:Feeding Methods; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D012042:Registries; D014188:Transposition of Great Vessels / Q000601:surgery
keywords: Neonate; cardiovascular ICU; cardiovascular surgery; feeding; nutrition