McKean Elissa B, Kasparian Nadine A, Batra Shweta, Sholler Gary F, Winlaw David S, Dalby-Payne Jacqueline
1Discipline of Paediatrics and Child Health,Sydney Medical School,The University of Sydney, Sydney,New South Wales,Australia.
3Heart Centre for Children,The Sydney Children's Hospitals Network (Westmead and Randwick),Sydney,New South Wales,Australia.
Cardiol Young. 2017 Aug;27(6):1203-1211. doi: 10.1017/S1047951116002845. Epub 2017 Jan 23.
Aim The aims of this study were to examine the prevalence and potential correlates of feeding difficulties in infants who underwent cardiac surgery in the neonatal period and to investigate resource utilisation by infants with feeding difficulties.
All neonates who underwent their first cardiac surgery at the Heart Centre for Children, The Children's Hospital at Westmead, between January and December, 2009 were included. Demographic, preoperative, intraoperative, and postoperative data were collected via electronic medical records. For the purpose of this study, feeding difficulty was defined as the requirement for ongoing tube feeding at the time of discharge home or transfer to another hospital.
Out of a total of 79 neonates, 24 (30%) were discharged home or transferred to another hospital with a feeding tube. Feeding difficulties were associated with the presence of a genetic syndrome (p<0.0001), assisted feeding preoperatively (odds ratio (OR)=4.4, p=0.03), and having a palliative procedure before biventricular repair (OR=5.1, p=0.02). Infants with feeding difficulties had significantly more reviews by speech pathologists (M=5.9, SD=7.9), dieticians (M=5.9, SD=5.4), and cardiac clinical nurse consultants (M=1.2, SD=1.4) compared with those without feeding difficulties.
This study identified factors that can be used in the early recognition of infant feeding difficulties, to help guide the direction of limited health resources, as well as being focal points for future research and clinical practice improvement.
目的 本研究的目的是检查新生儿期接受心脏手术的婴儿喂养困难的患病率及其潜在相关因素，并调查有喂养困难的婴儿的资源利用情况。
方法 纳入2009年1月至12月在韦斯特米德儿童医院儿童心脏中心接受首次心脏手术的所有新生儿。通过电子病历收集人口统计学、术前、术中和术后数据。在本研究中，喂养困难定义为出院回家或转至另一家医院时仍需持续鼻饲。
结果 在总共79名新生儿中，24名（30%）出院回家或转至另一家医院时带有鼻饲管。喂养困难与存在遗传综合征（p<0.0001）、术前辅助喂养（比值比（OR）=4.4，p=0.03）以及在双心室修复前进行姑息性手术（OR=5.1，p=0.02）有关。与没有喂养困难的婴儿相比，有喂养困难的婴儿接受言语病理学家（M=5.9，标准差=7.9）、营养师（M=5.9，标准差=5.4）和心脏临床护理顾问（M=1.2，标准差=1.4）会诊明显更多。
结论 本研究确定了可用于早期识别婴儿喂养困难的因素，有助于指导有限卫生资源的分配方向，也是未来研究和改进临床实践的重点。
