Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding.
Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children's hospital. 23 neonates born at ≥37weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7days for the control group and 40.9days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI -13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.
Division of Pediatric Critical Care, UCLA Mattel Children's Hospital, MDCC 12-494, 10833 LeConte, Los Angeles, CA 90095, United States. Electronic address: gitamohan@gmail.com.
Gitanjali
G
Indramohan
Department of Pediatrics, UCLA Mattel Children's Hospital, 757 Westwood Plaza, Room 3108, Los Angeles, CA 90095, United States. Electronic address: tiffpedigo8@gmail.com.
Tiffany P
TP
Pedigo
Department of Occupational Therapy and Rehabilitation Services, UCLA, 757 Westwood Plaza, Suite 3127, Box 957408, Los Angeles, CA 90095-7408, United States. Electronic address: otfortots@gmail.com.
Nicole
N
Rostoker
Department of Occupational Therapy and Rehabilitation Services, UCLA, 757 Westwood Plaza, Suite 3127, Box 957408, Los Angeles, CA 90095-7408, United States. Electronic address: mcambare@mednet.ucla.edu.
Mae
M
Cambare
Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, 911 Broxton Avenue, Room 314, Los Angeles, CA 90024, United States. Electronic address: tgrogan@mednet.ucla.edu.
Tristan
T
Grogan
Division of Pediatric Critical Care, UCLA Mattel Children's Hospital, MDCC 12-494, 10833 LeConte, Los Angeles, CA 90095, United States. Electronic address: mfederman@mednet.ucla.edu.
Myke D
MD
Federman
D003680:Deglutition Disorders / Q000209:etiology / Q000451:nursing*; D004750:Enteral Nutrition / Q000451:nursing*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000451:nursing* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000451:nursing*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Complex congenital heart disease; Gastrostomy tube feeding; Nasogastric tube feeding; Oral feeding; Oral motor intervention