@Article{chd.2022.021571,
AUTHOR = {Alyssia Venna, Kathleen Reid, Sarah Davis, Jiaxiang Gai, Yves d’Udekem, Sarah Clauss},
TITLE = {Preoperative Feeding in Single Ventricle Neonates is Predictive of Shorter Time to Goal Feed},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {17},
YEAR = {2022},
NUMBER = {5},
PAGES = {505--518},
URL = {http://www.techscience.com/schd/v17n5/49566},
ISSN = {3071-1738},
ABSTRACT = {<b>Background: </b>Patients with single ventricle anatomy are at increased risk of growth failure and malnutrition.
Amongst cardiac centers, there is little standardization of feeding practices in this complex population. We
hypothesized that initiation of our center’s preoperative feeding protocol would result in decreased gastrostomy
tube (G-tube) use, decreased length of stay and would not result in increased Necrotizing Enterocolitis (NEC)
rates. <b>Methods: </b>A single institution review of 52 patients who had undergone stage I single ventricle palliative
repair was performed. Patient diagnoses were hypoplastic left heart syndrome (39%), atrioventricular canal
(15%), and other (46%). Postoperative parameters such as time to goal feed and need for gastrostomy tube
(G-tube) were compared among preoperatively fed and non-preoperatively fed groups. Time to goal feed was
calculated as time from first postoperative enteral feed to goal volume of 100 mL/kg. <b>Results: </b>Of the 26 patients
who met inclusion criteria for preoperative feeding, 22 patients (85%) were fed prior to surgery. Cox proportional
hazard ratio revealed that age at surgery (<i>p</i> = 0.047) and being preoperatively fed (<i>p</i> = 0.001) were associated with
reaching goal feed sooner. Multivariable analysis revealed that being preoperatively fed made a patient twice as
likely to reach goal feed sooner (<i>p</i> = 0.047). Univariable logistic regression revealed that days on total parenteral
nutrition (<i>p</i> = 0.018), length of hospitalization (<i>p</i> = 0.008), and time to 1<sup>st</sup> postoperative feed (<i>p</i> = 0.020) were
significantly associated with higher odds of needing a G-tube postoperatively. Multivariable logistic regression
did not show any predictors of postoperative G-tube usage. However, there was a trend towards lower G-tube
usage in the preoperatively fed group. <b>Conclusions:</b> Implementing a standardized preoperative feeding protocol
in single ventricle neonates can result in significantly shorter time to goal feed in preoperatively fed patients. It is
beneficial for institutions to begin implementing standard feeding protocols to improve nutrition and growth
outcomes.},
DOI = {10.32604/chd.2022.021571}
}