Elgersma Kristin M, Trebilcock Anna L, Whipple Mary O, Tanner Lynn R, Pilditch Sarah J, Shah Kavisha M, McKechnie Anne Chevalier
University of Minnesota School of Nursing, Minneapolis, MN, USA.
Children's Minnesota, Minneapolis, MN, USA.
Pediatr Cardiol. 2023 Apr;44(4):769-794. doi: 10.1007/s00246-022-03049-x. Epub 2022 Nov 21.
Approximately 30-50% of infants undergoing neonatal surgery for congenital heart disease (CHD) cannot meet oral feeding goals by discharge and require feeding tube support at home. Feeding tubes are associated with increased readmission rates and consequent hospital, payer, and family costs, and are a burden for family caregivers. Identification of modifiable risk factors for oral feeding problems could support targeted care for at-risk infants. Therefore, the aim of this systematic review is to determine risk factors for tube feeding at discharge in infants undergoing neonatal surgery for CHD. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. Studies published before 2010 were excluded. The search resulted in 607 records, of which 18 were included. Studies were primarily retrospective cohort designs and results were often inconsistent. Study quality was assessed using the Joanna Briggs Critical Appraisal Tools. As a group, the studies exhibited substantial risk for bias. Based on the findings, infants who struggle with feeding preoperatively, experience increased nil per os duration and/or low oral feeding volume postoperatively, experience increased duration of mechanical ventilation, or have vocal cord dysfunction may be at risk for tube feeding at hospital discharge. Factors warranting further examination include cardiac physiology (e.g., aortic arch obstruction) and the relationship between neurodevelopment and oral feeding. Clinicians should use caution in assuming risk for an individual and prioritize early implementation of interventions that facilitate oral feeding development.
约30%-50%接受先天性心脏病（CHD）新生儿手术的婴儿在出院时无法达到经口喂养目标，需要在家中依靠喂养管辅助。喂养管与再入院率增加以及随之而来的医院、支付方和家庭成本增加相关，并且给家庭照顾者带来负担。识别经口喂养问题的可改变风险因素有助于为高危婴儿提供针对性护理。因此，本系统评价的目的是确定接受CHD新生儿手术的婴儿出院时需要管饲的风险因素。按照系统评价和Meta分析优先报告条目（PRISMA）指南，使用MEDLINE、护理学与健康领域数据库（CINAHL）和Cochrane系统评价数据库进行检索。排除2010年以前发表的研究。检索结果有607条记录，其中18条被纳入。研究主要为回顾性队列设计，结果往往不一致。使用乔安娜·布里格斯批判性评价工具评估研究质量。总体而言，这些研究存在较大偏倚风险。根据研究结果，术前喂养困难、术后禁食时间延长和/或经口喂养量少、机械通气时间延长或有声带功能障碍的婴儿在出院时可能有管饲风险。需要进一步研究的因素包括心脏生理学（如主动脉弓梗阻）以及神经发育与经口喂养之间的关系。临床医生在判断个体风险时应谨慎，并优先尽早实施促进经口喂养发育的干预措施。
