Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida.
Department of Pediatrics, Division of Pediatric Cardiology, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida.
Am J Perinatol. 2024 May;41(S 01):e2832-e2841. doi: 10.1055/s-0043-1775976. Epub 2023 Oct 17.
Oral feeding difficulty is common in infants after congenital heart disease (CHD) surgical repair and is associated with prolonged hospital stay and increased risk for tube-feeding at discharge (TF). The current understanding of the enteropathogenesis of oral feeding difficulty in infants requiring CHD surgery is limited. To determine the prevalence and risk factors for TF following CHD surgery in early infancy.
This was a 6-year single-center retrospective cohort study (2016-2021) of infants under 6 months who had CHD surgery. Infants required TF were compared with infants who reached independent oral feeding (IOF).
Of the final sample of 128 infants, 24 (18.8%) infants required TF at discharge. The risk factors for TF in univariate analysis include low birth weight, low 5-minute Apgar score, admitted at birth, risk adjustment in congenital heart surgery categories IV to VI, presence of genetic diagnosis, use of Prostin, higher pre- and postsurgery respiratory support, lower weight at surgery, lower presurgery oral feeding, higher presurgery milk calory, delayed postsurgery enteral and oral feeding, higher pre- and postsurgery gastroesophageal reflux disease (GERD), need for swallow study, abnormal brain magnetic resonance imaging ( < 0.05). In the multivariate analysis, only admitted at birth, higher presurgery milk calories, and GERD were significant risk factors for TF. TF had significantly longer hospital stay (72 vs. 17 days) and lower weight gain at discharge (-score: -3.59 vs. -1.94) compared with IOF ( < 0.05).
The prevalence of TF at discharge in our study is comparable to previous studies. Infants with CHD admitted at birth, received higher presurgery milk calories, and clinical GERD are significant risk factors for TF. Mitigating the effects of identified risk factors for TF will have significant impact on the quality of life for these infants and their families and may reduce health care cost.
· Oral feeding difficulty in infants after congenital heart disease surgical repair is common.. · Such infants require prolonged hospital stay and higher risk for tube-feeding at discharge.. · Identifying modifiable risk factors associated with tube-feeding can enhance clinical outcomes..
先天性心脏病（CHD）手术后的婴儿常出现口腔喂养困难，这与住院时间延长和出院时需要管饲喂养（TF）的风险增加有关。目前对于 CHD 手术后婴儿口腔喂养困难的发病机制了解有限。本研究旨在确定婴儿 CHD 手术后早期 TF 的发生率和危险因素。
这是一项 6 年的单中心回顾性队列研究（2016-2021 年），纳入了 6 个月以下接受 CHD 手术的婴儿。将需要 TF 的婴儿与达到独立口服喂养（IOF）的婴儿进行比较。
在最终的 128 例婴儿样本中，24 例（18.8%）婴儿在出院时需要 TF。单因素分析中 TF 的危险因素包括低出生体重、低 5 分钟 Apgar 评分、出生时入院、先天性心脏病手术分类 IV 至 VI 风险调整、存在遗传诊断、使用 Prostin、术前和术后呼吸支持更高、手术时体重更低、术前口服喂养更少、术前奶热量更高、术后肠内和口服喂养延迟、术前和术后胃食管反流病（GERD）更高、需要吞咽研究、异常脑磁共振成像（ < 0.05）。多因素分析中，仅出生时入院、术前奶热量更高和 GERD 是 TF 的显著危险因素。与 IOF 相比，TF 患儿的住院时间显著延长（72 天 vs. 17 天），出院时体重增加更少（-评分：-3.59 vs. -1.94）（ < 0.05）。
本研究中，婴儿在出院时需要 TF 的发生率与以往研究相当。出生时入院、术前接受较高奶热量和有临床 GERD 的 CHD 婴儿是 TF 的显著危险因素。减轻 TF 相关可识别危险因素的影响将对这些婴儿及其家庭的生活质量产生重大影响，并可能降低医疗保健成本。
先天性心脏病手术后婴儿口腔喂养困难很常见。
此类婴儿需要延长住院时间，出院时需要管饲喂养的风险增加。
确定与管饲喂养相关的可改变危险因素可以改善临床结局。
