Dabbagh Aseel, Miller Sarah, McCulloch Michael, Rosenthal Geoffrey, Conaway Mark, White Shelby
Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, USA.
Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, USA.
Pediatr Cardiol. 2025 Jan 8. doi: 10.1007/s00246-024-03750-z.
Though several studies have demonstrated that preoperative oral feeding (PO) can be safe in patients with congenital heart disease, they are commonly prohibited from doing so, potentially precluding the development of such skills. We sought to determine whether preoperative oral feeding is associated with freedom from tube feeding at postoperative discharge. Single-center, observational study including patients in the first month of life (≤ 30 days of age) who underwent a single cardiac surgery between 7/1/2017-6/30/2022 and survived to discharge. Preoperative PO was defined as any oral intake up to the day of cardiac surgery. General demographics and peri-operative characteristics were analyzed. A total of 235 patients were included of which 178 (78%) PO fed preoperatively, and 171 (73%) were discharged taking full PO. Those discharged without tube feeds received more preoperative oral feeds, were less likely to have a chromosomal abnormality/genetic syndrome, had lower STAT categories, and were less likely to have postoperative complications, vocal cord dysfunction or prolonged mechanical ventilation. Multivariate analysis found that any preoperative PO [odds ratio (OR) of 2.78 (CI 1.48, 5.24, p-value = 0.002)] and increasing amounts of PO were predictive of full PO intake at discharge [≤ 20 ml/kg/day (OR 2.06, CI 1.03, 4.14, p-value = 0.042) and > 20 ml/kg/day (OR 4.07, CI 1.88, 8.84, p-value = 0.004)]. Preoperative oral feeding is a strong predictor of discharging with full PO intake after cardiac surgery in the first month of life and that it may also improve with increasing volumes. Multi-institutional analyses are warranted.
尽管多项研究表明，先天性心脏病患者术前经口喂养（PO）可能是安全的，但患者通常被禁止这样做，这可能会妨碍此类技能的发展。我们试图确定术前经口喂养是否与术后出院时无需管饲相关。这是一项单中心观察性研究，纳入了2017年7月1日至2022年6月30日期间接受单次心脏手术且存活至出院的1个月龄及以下（≤30日龄）的患者。术前经口喂养定义为心脏手术当天之前的任何经口摄入量。分析了一般人口统计学和围手术期特征。共纳入235例患者，其中178例（78%）术前经口喂养，171例（73%）出院时完全经口喂养。无需管饲出院的患者术前经口喂养次数更多，染色体异常/遗传综合征的可能性更小，STAT分级更低，术后并发症、声带功能障碍或机械通气时间延长的可能性更小。多变量分析发现，任何术前经口喂养[比值比（OR）为2.78（CI 1.48，5.24，p值=0.002）]以及经口喂养量增加可预测出院时完全经口摄入量[≤20 ml/kg/天（OR 2.06，CI 1.03，4.14，p值=0.042）和>20 ml/kg/天（OR 4.07，CI 1.88，8.84，p值=0.004）]。术前经口喂养是1个月龄婴儿心脏手术后完全经口摄入出院的有力预测指标，并且随着摄入量增加可能也会改善。有必要进行多机构分析。
