Ehrmann Daniel E, Mulvahill Matthew, Harendt Shaunda, Church Jessica, Stimmler Amy, Vichayavilas Piyagarnt, Batz Sanja, Rodgers Jennifer, DiMaria Michael, Jaggers James, Barrett Cindy, Kaufman Jon
Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA.
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Congenit Heart Dis. 2018 Jan;13(1):31-37. doi: 10.1111/chd.12550. Epub 2017 Nov 17.
Feeding practices after neonatal and congenital heart surgery are complicated and variable, which may be associated with prolonged hospitalization length of stay (LOS). Systematic assessment of feeding skills after cardiac surgery may earlier identify those likely to have protracted feeding difficulties, which may promote standardization of care.
Neonates and infants ≤3 months old admitted for their first cardiac surgery were retrospectively identified during a 1-year period at a single center. A systematic feeding readiness assessment (FRA) was utilized to score infant feeding skills. FRA scores were assigned immediately prior to surgery and 1, 2, and 3 weeks after surgery. FRA scores were analyzed individually and in combination as predictors of gastrostomy tube (GT) placement prior to hospital discharge by logistic regression.
Eighty-six patients met inclusion criteria and 69 patients had complete data to be included in the final model. The mean age of admit was five days and 51% were male. Forty-six percent had single ventricle physiology. Twenty-nine (42%) underwent GT placement. The model containing both immediate presurgical and 1-week postoperative FRA scores was of highest utility in predicting discharge with GT (intercept odds = 10.9, P = .0002; sensitivity 69%, specificity 93%, AUC 0.913). The false positive rate was 7.5%.
In this analysis, systematic and standardized measurements of feeding readiness employed immediately before and one week after congenital cardiac surgery predicted need for GT placement prior to hospital discharge. The FRA score may be used to risk stratify patients based on likelihood of prolonged feeding difficulties, which may further improve standardization of care.
新生儿及先天性心脏病手术后的喂养方式复杂且多变，这可能与住院时间延长有关。对心脏手术后的喂养技能进行系统评估，可能有助于更早地识别出那些可能存在长期喂养困难的患儿，从而促进护理的标准化。
在单中心的1年期间，对首次接受心脏手术的3个月及以下的新生儿和婴儿进行回顾性识别。采用系统的喂养准备评估（FRA）对婴儿的喂养技能进行评分。FRA评分在手术前、术后1周、2周和3周时进行。通过逻辑回归分析FRA评分，单独或综合作为出院前胃造瘘管（GT）放置的预测指标。
86例患者符合纳入标准，69例患者有完整数据纳入最终模型。入院时的平均年龄为5天，51%为男性。46%患有单心室生理结构。29例（42%）接受了GT放置。包含术前即刻和术后1周FRA评分的模型在预测GT出院方面效用最高（截距比=10.9，P=.0002；敏感性69%，特异性93%，AUC 0.913）。假阳性率为7.5%。
在本分析中，先天性心脏手术前即刻和术后1周采用系统和标准化的喂养准备测量方法，可预测出院前GT放置的需求。FRA评分可用于根据长期喂养困难的可能性对患者进行风险分层，这可能进一步提高护理的标准化。
