The prevalence and effects of aspiration among neonates at the time of discharge.
BACKGROUND
Neonates undergoing heart surgery for CHD are at risk for postoperative gastrointestinal complications and aspiration events. There are limited data regarding the prevalence of aspiration after neonatal cardiothoracic surgery; thus, the effects of aspiration events on this patient population are not well understood. This retrospective chart review examined the prevalence and effects of aspiration among neonates who had undergone cardiac surgery at the time of their discharge. Introduction This study examined the prevalence of aspiration among neonates who had undergone cardiac surgery. Demographic data regarding these patients were analysed in order to determine risk factors for postoperative aspiration. Post-discharge feeding routes and therapeutic interventions were extracted to examine the time spent using alternate feeding routes because of aspiration risk or poor caloric intake. Modified barium swallow study results were used to evaluate the effectiveness of the test as a diagnostic tool. Materials and methods A retrospective study was undertaken of neonates who had undergone heart surgery from July, 2013 to January, 2014. Data describing patient demographics, feeding methods, and follow-up visits were recorded and compared using a χ2 test for goodness of fit and a Kaplan-Meier graph.


RESULTS
The patient population included 62 infants - 36 of whom were male, and 10 who were born with single-ventricle circulation. The median age at surgery was 6 days (interquartile range=4 to 10 days). Modified barium swallow study results showed that 46% of patients (n=29) aspirated or were at risk for aspiration, as indicated by laryngeal penetration. In addition, 48% (n=10) of subjects with a negative barium swallow or no swallow study demonstrated clinical aspiration events. Tube feedings were required by 66% (n=41) of the participants. The median time spent on tube feeds, whether in combination with oral feeds or exclusive use of a nasogastric or gastric tube, was 54 days; 44% (n=27) of patients received tube feedings for more than 120 days. Premature infants were significantly more likely to have aspiration events than infants delivered at full gestational age (OR p=0.002). Infants with single-ventricle circulation spent a longer time on tube feeds (median=95 days) than infants with two-ventricle defects (median=44 days); the type of cardiac defect was independent of prevalence of an aspiration event.


CONCLUSIONS
Aspiration is common following neonatal cardiac surgery. The modified barium swallow study is often used to identify aspiration events and to determine an infant's risk for aspirating. This leads to a high proportion of infants who require tube feedings following neonatal cardiac surgery.
1School of Nursing,University of Pennsylvania,Philadelphia,Pennsylvania,United States of America.
Emily
E
Karsch
1School of Nursing,University of Pennsylvania,Philadelphia,Pennsylvania,United States of America.
Sharon Y
SY
Irving
3Children's Healthcare of Atlanta,Emory University School of Medicine,Atlanta,Georgia,United States of America.
Brandon S
BS
Aylward
3Children's Healthcare of Atlanta,Emory University School of Medicine,Atlanta,Georgia,United States of America.
William T
WT
Mahle
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004750:Enteral Nutrition; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D053120:Respiratory Aspiration / Q000453:epidemiology*; D012189:Retrospective Studies
Aspiration; CHD; cardiothoracic surgery; modified barium swallow study; neonate; tube feeds