Hoch Jeannine M, Fatusin Oluwatosin, Yenokyan Gayane, Thompson W Reid, Lefton-Greif Maureen A
Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.
Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Congenit Heart Dis. 2019 May;14(3):438-445. doi: 10.1111/chd.12742. Epub 2019 Jan 12.
Tube feedings are often needed to achieve the growth and nutrition goals associated with decreased morbidity and mortality in patients with single ventricle anatomy. Variability in feeding method through the interstage period has been previously described, however, comparable information following stage 2 palliation is lacking.
To identify types of feeding methods following stage 2 palliation and their influence on length of stay.
Secondary analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry was performed on 932 patients. Demographic data, medical characteristics, postoperative complications, type of feeding method, and length of stay for stage 2 palliation were analyzed.
Type of feeding method remained relatively unchanged during hospitalization for stage 2 palliation. Gastrostomy tube fed only patients were the oldest at time of surgery (182.7 ± 57.7 days, P < .001) and had the lowest weight-for-age z scores at admission (-1.6 ± 1.4, P < .001). Oral + gastrostomy tube groups had the longest median bypass times (172.5 minutes, P = .001) and longest length of stay (median 12 days, P < .001). Multivariable modeling revealed that feeding by tube only (P < .001), oral + tube feeding (P ≤ .001), reintubation (P < .001), and prolonged intubation (P < .001) were associated with increased length of stay. Neither age (P = .156) nor weight-for-age z score at admission (P = .066) was predictive of length of stay.
Feeding methods established at admission for stage 2 palliation are not likely to change by discharge. Length of stay is more likely to be impacted by tube feeding and intubation history than age or weight-for-age z score at admission. Better understanding for selection of feeding methods and their impact on patient outcomes is needed to develop evidence-based guidelines to decrease variability in clinical practice patterns and provide appropriate counseling to caregivers.
对于单心室解剖结构的患者，通常需要通过管饲来实现与降低发病率和死亡率相关的生长及营养目标。此前已有关于过渡期喂养方法变异性的描述，然而，缺乏二期姑息治疗后类似的信息。
确定二期姑息治疗后的喂养方法类型及其对住院时间的影响。
对国家儿科心脏病学质量改进协作登记处的932例患者进行二次分析。分析了人口统计学数据、医学特征、术后并发症、喂养方法类型以及二期姑息治疗的住院时间。
在二期姑息治疗住院期间，喂养方法类型相对保持不变。仅接受胃造口管喂养的患者手术时年龄最大（182.7±57.7天，P<.001），入院时年龄别体重Z评分最低（-1.6±1.4，P<.001）。口服+胃造口管组的中位体外循环时间最长（172.5分钟，P=.001），住院时间最长（中位12天，P<.001）。多变量模型显示，仅通过管饲喂养（P<.001）、口服+管饲喂养（P≤.001）、再次插管（P<.001）和长时间插管（P<.001）与住院时间延长相关。年龄（P=.156）和入院时年龄别体重Z评分（P=.066）均不能预测住院时间。
二期姑息治疗入院时确定的喂养方法在出院时不太可能改变。住院时间更可能受到管饲喂养和插管史的影响，而不是年龄或入院时年龄别体重Z评分。需要更好地了解喂养方法的选择及其对患者结局的影响，以制定循证指南，减少临床实践模式的变异性，并为护理人员提供适当的指导。
