Multicenter evaluation of pre-operative feeding in infants with ductal dependent circulation

Authors

Jamie Penk, Department of Pediatrics, Lurie Children's Hospital, Chicago, IL, USA. jpenk@luriechildrens.org.
Will Cagle, Department of Pediatrics, Children's Hospital of Georgia, Augusta, GA, USA.
Adrian Holloway, Department of Pediatrics, Children's Hospital University of Maryland Medical Center, Baltimore, MD, USA.
Julie Connolly, Advocate Aurora Health
Alison Miles, Department of Anesthesia and Critical Care, John Hopkins All Children's Hospital, Baltimore, MD, USA.
Rupal Bhakta, Department of Pediatrics, Arkansas Children's, Little Rock, AR, USA.
Parag Jain, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Sarah Prochaska Davis, Department of Pediatrics, Children's National Medical Center, Washington, DC, USA.
Christine Riley, Department of Pediatrics, Children's National Medical Center, Washington, DC, USA.
Dantin Jeramy Roddy, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.

Recommended Citation

Penk J, Cagle W, Holloway A, et al. Multicenter Evaluation of Pre-operative Feeding in Infants with Ductal Dependent Circulation [published online ahead of print, 2023 May 20]. Pediatr Cardiol. 2023;10.1007/s00246-023-03182-1. doi:10.1007/s00246-023-03182-1

Affiliations

Advocate Children's Hospital

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.

Document Type

Article

PubMed ID

37209186