Factors Impacting Long-Term Gastrostomy Tube Dependence in Infants with Congenital Heart Disease

Complications that arise with nasogastric tubes after hospitalization in the pediatric population: A mixed methods systematic review

Children use nasogastric tubes (NGTs) to ensure optimum nutrition and medication delivery when oral feeding fails or when they experience faltering growth. Although this method is less invasive, children may experience complications associated with NGTs. There is a gap in the literature regarding the types and prevention of complications of NGTs in the pediatric population at home. This review determines at-home complications associated with NGTs in the pediatric population (aged 0-18 years) and the type of education and support provided to caregivers. Databases MEDLINE, Embase using the Ovid interface, and CINAHL using the EBSCOhost interface were searched for relevant studies from January 1946 to November 2022. Twenty-four articles were found, of which 16 studies with 902 children with NGTs feeding were systematically reviewed. Two themes emerged: (1) prevalence and types of NGT complications and (2) preventable complications and education/management strategies for prevention. Seven studies reported main complications of vomiting, retching and gagging, nausea, aspiration, local granulation tissue, and inadvertent removal, with two studies reporting no complications. Most complications were managed at home, suggesting caregivers were able to address issues without seeking additional medical intervention. Key recommendations to mitigate complications included training caregivers in NGT management, troubleshooting common complications, and evaluating caregiver competency before discharge. This systematic review emphasized the need for structured training programs to improve caregiver competence and safety practices, highlighting key areas for clinical improvement, including caregiver education, reducing at-home complications, and standardizing care for children using NGTs.

Operative Complications Following Gastrostomy Tube Placement After Cardiac Surgery During Infancy

INTRODUCTION

Gastrostomy tube (GT) placement is common in infants following repair of congenital heart defects. We aimed to determine rate of operative complications and predictors of short-term GT use to counsel parents regarding the risks and benefits of GT placement.

METHODS

We reviewed infants aged <1 y with congenital heart disease who underwent GT placement after cardiac surgery between 2018 and 2021. Demographics and clinical data were collected and analyzed. Comparisons were made between infants who required the GT for more than 1 y and those who required the GT for less than 1 y.

RESULTS

One hundred thirty three infants were included; 35 (26%) suffered one or more complication including wound infection (4, 3%), granulation tissue (3, 2%), tube dislodgement (10), leakage from the tube (9), unplanned emergency department visit (15), and unplanned readmission (1). Thirty-four infants used the GT for feeds for 1 y or less (26%) including 17 (13%) who used it for 3 mo or less. Fifty-six infants had their GT removed during the study period (42%), 20 of whom required gastrocutaneous fistula closure (36%). Thirty-three infants had a GT placed on or before day of life 30, 17 (52%) used the GT for less than 1 y, and 10 (31%) used it for 3 mo or less.

CONCLUSIONS

GT placement is associated with a relatively high complication and reoperation rate. GT placement in infants aged less than 30 d is associated with shorter duration of use. Risks, benefits, and alternatives such as nasogastric tube feeds should be discussed in the shared decision-making process for selected infants.

Quantifying the Healthcare Burden of Pediatric Feeding Disorder after Congenital Heart Surgery

OBJECTIVE

To determine the healthcare costs and use burden of pediatric feeding disorder after congenital heart surgery.

STUDY DESIGN

A retrospective, population-based cohort study using claims data (2009-2018) was performed. Participants include patients aged 0-18 years who had undergone congenital heart surgery and were included in the insurance database ≥1 year after surgery. The main exposure variable was the presence of a pediatric feeding disorder, defined as a need for a feeding tube at discharge or diagnosis of dysphagia or feeding-related difficulty within the study timeframe. Main outcomes include overall and feeding-related medical care use, defined as readmissions and outpatient use, and feeding-related cost of care within 1 year of surgery.

RESULTS

A total of 10 849 pediatric patients were identified, with 3347 (30.9%) presenting with pediatric feeding disorder within 1 year of surgery. Patients with pediatric feeding disorder spent a median of 12 days (IQR, 6-33 days) in the hospital, compared with 5 days (IQR, 3-8 days) in patients without (P < .001). Rate ratios for overall readmissions, feeding-related readmissions, feeding-related outpatient use, and cost of care over the first year after surgery were significantly increased at 2.9 (95% CI, 2.5-3.4), 5.1 (95% CI, 4.6-5.7), 7.7 (95% CI, 6.5-9.1), and 2.2 (95% CI, 2.0-2.3) among patients with pediatric feeding disorder as compared with those without.

CONCLUSIONS

Pediatric feeding disorder after congenital heart surgery is associated with a significant healthcare burden. Multidisciplinary care for and research on this health condition is needed to identify optimal management strategies to reduce this burden and improve outcomes.

Determinants of Length of Stay after Neonatal Cardiac Surgery Using Path Analysis

After neonatal cardiac surgery, families, and the health care team strive for exclusive oral feedings before hospital discharge. With the hypothesis that exclusive oral feedings would reduce the length of stay (LOS), a multidimensional path analysis was used to examine a cross-section of 280 neonates from 2009 to 2013. Buttigieg, Abela, and Pace's theoretical framework of structural and process-related determinants of LOS was modeled with hypothesis-driven correlation and directionality. The recursive path model had a good global and local fit with outcome variances of 26% for exclusive oral feeding and LOS. In the full cohort and model groups (single and biventricular), when controlling for covariances: sepsis, birth distance, necrotizing enterocolitis, genetic differences, specialty consults, the age at which neonatal cardiac surgery occurred (β = .23, p ≤ .001) and the duration of postoperative intubation (β = .47, p ≤ .001) more significantly influenced the LOS than intermediate mediation of exclusive oral feedings at discharge.