Abstract
Enteral feeds are often withheld from neonates with ductal dependent cardiac lesions who are receiving prostaglandins. This is despite positive benefits of enteral feeding. We describe a multicenter cohort of these neonates who were fed pre-operatively. We also give a granular description of vital sign measurements and other risk factors prior to feeding. A retrospective chart review was performed at seven centers. Inclusion criteria were full-term neonates under one month of age with ductal dependent lesions receiving prostaglandins. These neonates were fed for at least 24 h during the pre-operative period. Premature neonates were excluded. Using the inclusion criteria, 127 neonates were identified. While being fed, 20.5% of the neonates were intubated, 10.2% were on inotropes, and 55.9% had an umbilical arterial catheter in place. Median oxygen saturations in the six hours prior to feeding were 92.5% in patients with cyanotic lesions, median diastolic blood pressure was 38 mmHg and median somatic NIRS were 66.5%. The median peak daily feeding volume reached was 29 ml/kg/day (IQ range 15.5–96.8 ml/kg/day). One patient developed suspected necrotizing enterocolitis (NEC) in this cohort. Only one adverse event occurred, which was an aspiration thought to be related to feeding, but did not result in intubation or cessation of feeds. NEC was rare among neonates with ductal dependent lesions while receiving enteral nutrition pre-operatively. Umbilical arterial catheters were in place in the majority of these patients. Hemodynamic measures demonstrated a high median oxygen saturation prior to initiation of feeds.
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References
Tume L, Balmaks R, da Cruz E et al (2018) Enteral feeding practices in infants with congenital heart disease across european picus: a european society of pediatric and neonatal intensive care survey. PCCM 19(2):137–144
Dunn L, Hulman S, Weiner J, Kliegman R (1988) Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointesting function: preliminary report of a randomized trial. J Pediatra 112(4):622–629
Fliden-Rimon O, Friedman S, Lev E et al (2004) Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Childh 89:F283–F283
Venna A, Reid K, Davis S et al (2022) Preoperative feeding in single ventricle neonates is predictive of shorter time to goal feed. Congenit Heart Dis 17(5):505–518
Toms R, Jackson K, Dabal R et al (2015) Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenit Heart Dis 10:36–42
Natarajan G, Reddy A, Aggarwal S (2010) Enteral feeding of neonates with congenital heart disease. Neonatology 98(4):330–336
Willis L, Thureen P, Kaufman J (2008) Enteral feeding in Prostaglandin-dependent neonates: is is safe practice? J Pediatr 153(6):867–869
Becker K, Hornik C, Cotton C (2015) Necrotizing enterocolitis in infants with ductal-dependent congenital heart disease. Am J Perinatol 32(7):633–638
Walsh M, Kliegman R (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33(1):179–201
Day T, Dionisio D, Zannino D et al (2019) Enteral feeding in duct-dependent congenital heart disease. J Neonatal Perinatal Med 12(1):9–12
Kataria-Hale J, Osborne S, Hair A et al (2019) Preoperative feeds in ductal-dependent cardiac disease: a systematic review and meta-analysis. Hosp Pediatr 9(12):998–1006
Davey A, Wagner C, Cox C, Kendig J (1994) Feeding premature infants while low umbilical artery catheters are in place: a prospective, randomized trial. J Pediatr 124(5):795–9
Scahill C, Graham E, Atz A et al (2017) Preoperative feeding and necrotizing enterocolitis: Is the fear justified? World J Pediatr Congenit Heart Surg 8(1):62–68
Cognata A, Kataria-Hale J, Griffiths P et al (2019) Human milk use in the preopertive period is associated with a lower risk for necrotizing enterocolitis in neonates with complex congenital heart disease. J Pediatr 215:11–16
Acknowledgements
We would like to acknowledge Kathleen Van’t Hof and Cheryl Lefaiver PhD, RN for their invaluable contributions in navigating the agreements needed to make this project possible.
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JP and JR prepared most of the prepared manuscript. JP, PJ, JR, and JC helped design this study and set up the implementation of the study. JP, WC, AH, AM, RB, SP, CR, and DJR were the primary data extractors. All authors reviewed the manuscript and helped with editing.
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Penk, J., Cagle, W., Holloway, A. et al. Multicenter Evaluation of Pre-operative Feeding in Infants with Ductal Dependent Circulation. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03182-1
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DOI: https://doi.org/10.1007/s00246-023-03182-1