Open Access

ARTICLE

Preoperative Feeding in Single Ventricle Neonates is Predictive of Shorter Time to Goal Feed

by Alyssia Venna¹, Kathleen Reid², Sarah Davis², Jiaxiang Gai³, Yves d’Udekem¹, Sarah Clauss^2,*

1 Department of Cardiovascular Surgery, Children’s National Heart Institute, The George Washington University School of Medicine, Washington DC, USA
2 Department of Cardiology, Children’s National Heart Institute, The George Washington University School of Medicine, Washington DC, USA
3 Department of Biostatistics, Children’s National Heart Institute, The George Washington University School of Medicine, Washington DC, USA

* Corresponding Author: Sarah Clauss. Email:

Congenital Heart Disease 2022, 17(5), 505-518. https://doi.org/10.32604/chd.2022.021571

Received 21 March 2022; Accepted 30 May 2022; Issue published 06 September 2022

Abstract

Background: Patients with single ventricle anatomy are at increased risk of growth failure and malnutrition. Amongst cardiac centers, there is little standardization of feeding practices in this complex population. We hypothesized that initiation of our center’s preoperative feeding protocol would result in decreased gastrostomy tube (G-tube) use, decreased length of stay and would not result in increased Necrotizing Enterocolitis (NEC) rates. Methods: A single institution review of 52 patients who had undergone stage I single ventricle palliative repair was performed. Patient diagnoses were hypoplastic left heart syndrome (39%), atrioventricular canal (15%), and other (46%). Postoperative parameters such as time to goal feed and need for gastrostomy tube (G-tube) were compared among preoperatively fed and non-preoperatively fed groups. Time to goal feed was calculated as time from first postoperative enteral feed to goal volume of 100 mL/kg. Results: Of the 26 patients who met inclusion criteria for preoperative feeding, 22 patients (85%) were fed prior to surgery. Cox proportional hazard ratio revealed that age at surgery (p = 0.047) and being preoperatively fed (p = 0.001) were associated with reaching goal feed sooner. Multivariable analysis revealed that being preoperatively fed made a patient twice as likely to reach goal feed sooner (p = 0.047). Univariable logistic regression revealed that days on total parenteral nutrition (p = 0.018), length of hospitalization (p = 0.008), and time to 1^st postoperative feed (p = 0.020) were significantly associated with higher odds of needing a G-tube postoperatively. Multivariable logistic regression did not show any predictors of postoperative G-tube usage. However, there was a trend towards lower G-tube usage in the preoperatively fed group. Conclusions: Implementing a standardized preoperative feeding protocol in single ventricle neonates can result in significantly shorter time to goal feed in preoperatively fed patients. It is beneficial for institutions to begin implementing standard feeding protocols to improve nutrition and growth outcomes.

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