No CrossRef data available.
Article contents
Pre-operative enteral feeding in single-ventricle CHD patients and necrotising enterocolitis risk
Published online by Cambridge University Press: 12 July 2023
Abstract
Introduction:
Enteral feeding prior to cardiac surgery has benefits in pre-operative and post-operative patient statuses. In 2020, to increase pre-operative feeding for single-ventricle patients prior to stage 1 palliation, an enteral feeding algorithm was created. The aim of this study is to monitor the impact of our practice change with the primary outcome of necrotising enterocolitis incidence from birth to 2 weeks following surgical intervention.
Methods:
This is a single-site, retrospective cohort study including patients from 1 March, 2018 to 1 July, 2022. Variables assessed include demographics, age at cardiac surgery, primary cardiac diagnosis, necrotising enterocolitis pre-operative and 2 weeks post-operative cardiac surgery, feeding route, feeding type, volume of trophic enteral feeds, and near-infrared spectroscopy.
Results:
Following implementation of a pre-operative enteral feeding algorithm, the rate of neonates fed prior to surgery increased (39.5–75%, p = .001). The feedings included a mean volume of 28.24 ± 11.16 ml/kg/day, 83% fed breastmilk only, 44.4% tube fed, and 55.5% of infants had all oral feedings. Comparing enterally fed neonates and those not enterally fed, the necrotising enterocolitis incidence from birth to 2 weeks post-op was not significantly increased (p = 0.926).
Conclusion:
As a result of implementing our feeding algorithm, the frequency of infants fed prior to stage I Norwood or Hybrid surgeries increased to 75%, and there was no significant change in the incidence of necrotising enterocolitis. This study confirmed that pre-operative enteral feeds are safe and are not associated with increased incidence of necrotising enterocolitis.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press
References
Singh, DK, Miller, CM, Orgel, KA, Dave, M, Mackay, S, Good, M. Necrotizing enterocolitis: bench to bedside approaches and advancing our understanding of disease pathogenesis. Front Pediatr 2023; 10: 1107404. DOI: 10.3389/fped.2022.1107404.CrossRefGoogle ScholarPubMed
Kataria-Hale, J, Osborne, SW, Hair, A, Hagan, J, Pammi, M. Preoperative feeds in ductal-dependent cardiac disease: a systematic review and meta-analysis. Hosp Pediatr 2019; 9: 998–1006. DOI: 10.1542/hpeds.2019-0111.CrossRefGoogle ScholarPubMed
Spinner, JA, Morris, SA, Nandi, D, et al. Necrotizing enterocolitis and associated mortality in neonates with congenital heart disease: a multi-institutional study. Pediatr Crit Care Med 2020; 21: 228–234. DOI: 10.1097/PCC.0000000000002133.CrossRefGoogle ScholarPubMed
Burge, KY, Gunasekaran, A, Makoni, MM, Mir, AM, Burkhart, HM, Chaaban, H. Clinical characteristics and potential pathogenesis of cardiac necrotizing enterocolitis in neonates with congenital heart disease: a narrative review. J Clin Med 2022; 11: 3987. DOI: 10.3390/jcm11143987.CrossRefGoogle ScholarPubMed
Slicker, J, Sables-Baus, S, Lambert, LM, Peterson, LE, Woodard, FK, Ocampo, EC. National pediatric cardiology-quality improvement collaborative feeding work group. perioperative feeding approaches in single ventricle infants: a survey of 46 centers. Congenit Heart Dis 2016; 11: 707–715. DOI: 10.1111/chd.12390.CrossRefGoogle ScholarPubMed
Nordenström, K, Lannering, K, Mellander, M, Elfvin, A. Low risk of necrotising enterocolitis in enterally fed neonates with critical heart disease: an observational study. Arch Dis Child Fetal Neonatal Ed 2020; 105: 609–614. DOI: 10.1136/archdischild-2019-318537.CrossRefGoogle ScholarPubMed
Martini, S, Beghetti, I, Annunziata, M, et al. Enteral nutrition in term infants with congenital heart disease: knowledge gaps and future directions to improve clinical practice. Nutrients 2001; 13: 932. DOI: 10.3390/nu13030932.CrossRefGoogle Scholar
Herridge, J, Tedesco-Bruce, A, Gray, SB, Floh, AA. Feeding the child with congenital heart disease: a narrative review. Pediatr Med 2021; 4: 7–7. DOI: 10.21037/PM-20-77.CrossRefGoogle Scholar
Toms, R, Jackson, KW, Dabal, RJ, Reebals, CH, Alten, JA. Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 2015; 10: 36–42. DOI: 10.1111/chd.12177.CrossRefGoogle ScholarPubMed
Kelleher, ST, McMahon, CJ, James, A. Necrotizing enterocolitis in children with congenital heart disease: a literature review. Pediatr Cardiol 2021; 42: 1688–1699. DOI: 10.1007/s00246-021-02691-1.CrossRefGoogle ScholarPubMed
Cognata, A, Kataria-Hale, J, Griffiths, P, et al. Human milk use in the preoperative period is associated with a lower risk for necrotizing enterocolitis in neonates with complex congenital heart disease. J Pediatr 2019; 215: 11–16.e2. DOI: 10.1016/j.jpeds.2019.08.009.CrossRefGoogle ScholarPubMed
Scahill, CJ, Graham, EM, Atz, AM, Bradley, SM, Kavarana, MN, Zyblewski, SC. Preoperative feeding neonates with cardiac disease. World J Pediatr Congenit Heart Surg 2017; 8: 62–68. DOI: 10.1177/2150135116668833.CrossRefGoogle ScholarPubMed
Sagiv, E, Tjoeng, YL, Davis, M, et al. Assessing the association between pre-operative feeding and the development of oral feeding skills in infants with single ventricle heart disease: an analysis of the NPC-qIC dataset. Pediatr Cardiol 2022; 43: 1141–1155. DOI: 10.1007/s00246-022-02837-9.CrossRefGoogle ScholarPubMed
Bell, MJ, Ternberg, JL, Feigin, RD, et al. Neonatal necrotizing enterocolitis. therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7. DOI: 10.1097/00000658-197801000-00001.CrossRefGoogle ScholarPubMed
Walsh, MC, Kliegman, RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33: 179–201. DOI: 10.1016/s0031-3955(16)34975-6.CrossRefGoogle ScholarPubMed
DeWitt, AG, Charpie, JR, Donohue, JE, Yu, S, Owens, GE. Splanchnic near-infrared spectroscopy and risk of necrotizing enterocolitis after neonatal heart surgery. Pediatr Cardiol 2014; 35: 1286–1294. DOI: 10.1007/s00246-014-0931-5.CrossRefGoogle ScholarPubMed
Becker, KC, Hornik, CP, Cotten, CM, et al. Necrotizing enterocolitis in infants with ductal-dependent congenital heart disease. Am J Perinatol 2015; 32: 633–638. DOI: 10.1055/s-0034-1390349.CrossRefGoogle ScholarPubMed
Havranek, T, Johanboeke, P, Madramootoo, C, Carver, JD. Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings. J Perinatol 2007; 27: 375–379. DOI: 10.1038/sj.jp.7211691.CrossRefGoogle Scholar
Surmeli Onay, O, Velipasaoğlu, M, Tutal, M, Sarılar, TD, et al. The effect of drip versus intermittent feeding on splanchnic oxygenation in preterm infants with intrauterine growth restriction: a prospective randomized trial. Eur J Pediatr 2023; 182: 1317–1328. DOI: 10.1007/s00431-023-04810-x.CrossRefGoogle ScholarPubMed
Owens, GE, King, K, Gurney, JG, Charpie, JR. Low renal oximetry correlates with acute kidney injury after infant cardiac surgery. Pediatr Cardiol 2011; 32: 183–188. DOI: 10.1007/s00246-010-9839-x.CrossRefGoogle ScholarPubMed