Perioperative Feeding Approaches in Single Ventricle Infants: A Survey of 46 Centers
Author Contributions: The study was conceptualized and designed by the members of the Feeding Work Group of the National Pediatric Cardiology—Quality Improvement Collaborative as a group. Ms. Slicker conceptualized and designed the study, drafted the initial abstract and approved the final manuscript as submitted. Dr. Sables-Baus conceptualized and designed the study, contributed to the body of the article, reviewed and revised the manuscript and approved the final manuscript as submitted. Ms. Lambert critically reviewed and revised the article, and approved the final manuscript as submitted. Ms. Peterson critically reviewed and revised the article, and approved the final manuscript as submitted. Ms. Woodard critically reviewed the article, and approved the final manuscript as submitted. Dr. Ocampo conceptualized and designed the study, drafted and contributed substantially to the article, performed the analysis and interpretation of results and approved the final manuscript as submitted.
Conflict of interest: None.
Abstract
Background Feeding dysfunction occurs commonly in infants with single ventricle heart disease and impacts growth and long-term outcomes. Little evidence exists to guide safe feeding in this population. This study surveyed centers participating in the National Pediatric Cardiology Quality Improvement Collaborative to assess prevailing feeding practices amongthose caring for single ventricle neonates.
Methods Web-based survey of 56 pediatric cardiac surgical centers was conducted. Questions addressed peri-operative feeding approaches and responses were presented and analyzed descriptively.
Results Of 56 centers, 46 (82%) completed a survey. Preoperative feeding was common in single ventricle infants (30/46; 65%), routes varied. Centers who did not feed infants preoperatively cited the risk of necrotizing enterocolitis (16/16; 100%), presence of umbilical artery catheter (12/16; 75%), and prostaglandin infusion (9/16; 56%) as main concerns. 67% of centers reported no specific vital sign thresholds for withholding enteral feedings. In the postoperative period, most centers used an “internal guideline” (21/46; 46%) or an “informal practice” (15/46; 33%) to determine feeding readiness. Approaches to findings were significantly different among centers. About 40% of centers did not send patients home with feeding tubes, and there was no clear consensus between preferred feeding tube modality at discharge.
Conclusion Considerable variation exists in feeding practices for infants with single ventricle congenital heart disease among 46 centers participating in a quality improvement collaborative. Although most centers generally feed infants preoperatively, feeding practices remain center-specific. Variability continues in the immediate post-operative and interstage periods. Further opportunities exist for investigation, standardization and development of best-practice feeding guidelines.
