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Mohiuddin TA, Raol N, Tey CS, Horný M, Zhang C, Sharp WG, Chanani N, Patzer RE. Quantifying the Healthcare Burden of Pediatric Feeding Disorder after Congenital Heart Surgery. J Pediatr 2023; 261:113593. [PMID: 37399917 DOI: 10.1016/j.jpeds.2023.113593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/27/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
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.
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Affiliation(s)
- Tahmina A Mohiuddin
- Medical Scholars Program, Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Nikhila Raol
- Department of Otolaryngology, Emory School of Medicine, Atlanta, GA; Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Ching S Tey
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA; Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA
| | - Chao Zhang
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA
| | - William G Sharp
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Children's Feeding Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Nikhil Chanani
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA; Childrens Healthcare of Atlanta, Atlanta, GA; Sibley Heart Center, Alpharetta, GA; Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rachel E Patzer
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA
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Ubeda Tikkanen A, Vova J, Holman L, Chrisman M, Clarkson K, Santiago R, Schonberger L, White K, Badaly D, Gauthier N, Pham TDN, Britt JJ, Crouter SE, Giangregorio M, Nathan M, Akamagwuna UO. Core components of a rehabilitation program in pediatric cardiac disease. Front Pediatr 2023; 11:1104794. [PMID: 37334215 PMCID: PMC10275574 DOI: 10.3389/fped.2023.1104794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Joshua Vova
- Department of Physiatry, Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Lainie Holman
- Department Pediatric Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Maddie Chrisman
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kristin Clarkson
- Department of Pediatric Physical Medicine and Rehabilitation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Santiago
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Lisa Schonberger
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Kelsey White
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY, United States
| | - Naomi Gauthier
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Tam Dan N. Pham
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Jolie J. Britt
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Scott E. Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee Knoxville, Knoxville, IL, United States
| | - Maeve Giangregorio
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
| | - Unoma O. Akamagwuna
- Department Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, United States
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, TX, United States
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3
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Desai H, Jones CE, Fogel JL, Negrin KA, Slater NL, Morris K, Doody LR, Engstler K, Torzone A, Smith J, Butler SC. Assessment and management of feeding difficulties for infants with complex CHD. Cardiol Young 2022; 33:1-10. [PMID: 36562257 DOI: 10.1017/s1047951122004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.
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Affiliation(s)
- Hema Desai
- Department of Rehabilitation Services, Children's Hospital of Orange County, Orange, CA, USA
| | - Courtney E Jones
- Acute Care Therapy Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jennifer L Fogel
- Department of Pediatric Rehabilitation, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Karli A Negrin
- Department of Therapy and Rehabilitative Services, Nemours Children's Health, Wilmington, DE, USA
| | - Nancy L Slater
- Physical Medicine and Rehabilitation Services, Children's Minnesota, Minneapolis, MN, USA
| | - Kimberly Morris
- Department of Speech-Language Pathology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Lisa R Doody
- Pediatric Rehabilitation and Development, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Katherine Engstler
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Torzone
- Heart Center, Cardiac Intensive Care Unit, Children's Medical Center Dallas, Dallas, TX, USA
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4
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Elgersma KM, Trebilcock AL, Whipple MO, Tanner LR, Pilditch SJ, Shah KM, McKechnie AC. Risk Factors for Tube Feeding at Discharge in Infants Undergoing Neonatal Surgery for Congenital Heart Disease: A Systematic Review. Pediatr Cardiol 2022. [PMID: 36404346 DOI: 10.1007/s00246-022-03049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022]
Abstract
Approximately 30-50% of infants undergoing neonatal surgery for congenital heart disease (CHD) cannot meet oral feeding goals by discharge and require feeding tube support at home. Feeding tubes are associated with increased readmission rates and consequent hospital, payer, and family costs, and are a burden for family caregivers. Identification of modifiable risk factors for oral feeding problems could support targeted care for at-risk infants. Therefore, the aim of this systematic review is to determine risk factors for tube feeding at discharge in infants undergoing neonatal surgery for CHD. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. Studies published before 2010 were excluded. The search resulted in 607 records, of which 18 were included. Studies were primarily retrospective cohort designs and results were often inconsistent. Study quality was assessed using the Joanna Briggs Critical Appraisal Tools. As a group, the studies exhibited substantial risk for bias. Based on the findings, infants who struggle with feeding preoperatively, experience increased nil per os duration and/or low oral feeding volume postoperatively, experience increased duration of mechanical ventilation, or have vocal cord dysfunction may be at risk for tube feeding at hospital discharge. Factors warranting further examination include cardiac physiology (e.g., aortic arch obstruction) and the relationship between neurodevelopment and oral feeding. Clinicians should use caution in assuming risk for an individual and prioritize early implementation of interventions that facilitate oral feeding development.
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5
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Willson L, Spence K. Development of a Foundation Protocol for Feeding Complex Care Neonates and Enablers and Barriers to Its Implementation. Compr Child Adolesc Nurs 2022. [DOI: 10.1080/24694193.2022.2053613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Louise Willson
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Australia
| | - Kaye Spence
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Australia
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Elgersma KM, McKechnie AC, Schorr EN, Shah KM, Trebilcock AL, Ramel SE, Ambrose MB, Swanson NM, Sommerness SA, Spatz DL. The Impact of Human Milk on Outcomes for Infants with Congenital Heart Disease: A Systematic Review. Breastfeed Med 2022; 17:393-411. [PMID: 35167760 DOI: 10.1089/bfm.2021.0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Infants with congenital heart disease (CHD) are at risk for feeding-related morbidity and mortality, with growth failure and oral feeding problems associated with poor outcomes. The benefits of human milk (HM) for preterm infants have been well documented, but evidence on HM for infants with CHD has recently begun to emerge. Objectives: Our primary aim was to examine the impact of HM feeding on outcomes for infants with CHD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. The quality of each study was assessed using the Joanna Briggs Critical Appraisal Tools. A total of 16 studies were included. Results: There was evidence that an exclusive HM diet reduces the risk of necrotizing enterocolitis (NEC) for infants with CHD. Evidence with a higher risk for bias indicated that a well-managed HM diet may be associated with improved growth, shorter length of stay, and improved postoperative feeding and nutritional outcomes. Chylothorax outcomes were similar between modified HM and medium-chain triglyceride formula. The studies had significant limitations related to power, lack of control for covariates, and inconsistent delineation of feeding groups. Conclusions: Based on the reduced risk for NEC and given the conclusive benefits in other vulnerable populations, we recommend that clinicians and institutions prioritize programs to support HM feeding for infants with CHD. Large high-quality studies are needed to validate these results. Future work should clarify best practices in managing an HM diet to support optimal growth and development for these infants.
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Affiliation(s)
| | | | - Erica N Schorr
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Kavisha M Shah
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Anna L Trebilcock
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Sara E Ramel
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Matthew B Ambrose
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Nellie Munn Swanson
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Nursing, Children's Minnesota, Minneapolis, Minnesota, USA
| | | | - Diane L Spatz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Center for Nursing Research & Evidence Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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7
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Elgersma KM, McKechnie AC, Gallagher T, Trebilcock AL, Pridham KF, Spatz DL. Feeding infants with complex congenital heart disease: a modified Delphi survey to examine potential research and practice gaps. Cardiol Young 2021; 31:577-88. [PMID: 33303041 DOI: 10.1017/S1047951120004370] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management. MATERIALS AND METHODS A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data. RESULTS Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure. CONCLUSIONS The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.
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8
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Jensen AR, Rao R, Herrmann JL, Markel TA, Gray BW. Surgical Gastrostomy in Pediatric Patients Undergoing Cardiac Surgery. J Surg Res 2021; 259:516-22. [PMID: 33218701 DOI: 10.1016/j.jss.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Practices of performing gastrostomy tubes vary across institutions for patients undergoing cardiac surgery. We aim to elucidate the outcomes of gastrostomy and the duration of feeding assistance in these patients. MATERIALS AND METHODS Patients undergoing cardiac surgery (CS) at our institution from 2013 to 2017 were retrospectively reviewed using the Society of Thoracic Surgery database. A cohort of non-CS patients undergoing gastrostomy tube (g-tube) placement from 2013 to 2015 was used as control. Technical complications and postoperative feeding intolerance were analyzed. Duration of need for g-tube was also analyzed in patients undergoing CS. RESULTS The CS group had 144 patients, and the non-CS group had 677 patients. CS patients had a higher incidence of feeding intolerance (18.8% versus 5.6%, P < 0.001) and took longer to attain full feeds (median of 2 versus 1 d, P < 0.001), and this was confirmed on propensity matched analysis. In addition, technical g-tube complications were similar in the two groups. No mortality in CS was attributed to the g-tube. 58% of patients undergoing CS were able to wean from g-tube feeding by 6-12 mo after g-tube placement. CONCLUSIONS G-tube placement in patients undergoing CS by any technique is safe without increased complications. A significant portion of these patients was able to wean off supplemental enteral feeding assistance by a year after g-tube placement.
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Shahi N, Phillips R, Meier M, Shirek G, Goldsmith A, Soden JS, Kaufman J, Moulton S. Gastrostomy Button Placement in Infants With Cyanotic Versus Acyanotic Congenital Heart Disease. J Surg Res 2020; 259:407-413. [PMID: 33616074 DOI: 10.1016/j.jss.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infants with congenital heart disease (CHD) may exhibit increased metabolic demands, and many will undergo placement of a gastrostomy to achieve adequate nutritional intake. There is a paucity of data, however, comparing the operative risks and overall complications of gastrostomy placement in cyanotic versus acyanotic infants with CHD. We hypothesized that patients with cyanotic CHD would have a higher rate of gastrostomy-associated complications than infants with acyanotic CHD. METHODS We retrospectively reviewed patients who underwent gastrostomy button placement after cardiac surgery for CHD between 2013 and 2018. Patients were stratified into cyanotic CHD and acyanotic CHD cohorts. Patient data were extracted from the Society of Thoracic Surgeons database and merged with clinical data related to gastrostomy placement and complications from chart review. Unadjusted analyses were used to find covariates associated with cyanotic CHD and acyanotic CHD, using a t-test or Wilcoxon rank-sum test for continuous data, depending on normalcy, and χ2 or Fisher's exact tests for categorical data depending on the distribution. RESULTS There were 257 infants with CHD who underwent gastrostomy placement during the study period, of which 86 had cyanotic CHD. There were no significant differences in baseline weight or preoperative albumin levels between the two groups. Patients with cyanotic CHD had a lower incidence of comorbid syndromes (P = 0.0001), higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores (P < 0.0001), and higher postoperative mortality rate (P = 0.0189). There was a higher rate of granulation tissue formation in patients with acyanotic CHD (48.5% versus 22.1%, P < 0.0001). There were no differences in other gastrostomy button-related complications, including leakage, wound infection, or dislodgement. CONCLUSIONS Patients with acyanotic CHD demonstrated a higher incidence of granulation tissue. We found no difference in gastrostomy-specific complication rates between the two groups, with the notable exception of granulation tissue formation. Based on this study, the diagnosis of cyanotic CHD does not increase the risk of gastrostomy-related complications.
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Affiliation(s)
- Niti Shahi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Ryan Phillips
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Gabrielle Shirek
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Adam Goldsmith
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Jason S Soden
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - Jon Kaufman
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatric Cardiology, Children's Hospital Colorado, Aurora, Colorado
| | - Steven Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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10
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Abstract
Malnutrition occurs when nutrient intake does not meet the needs for normal body functions and as a consequence leads to alterations of growth and development in children. Chronic illness puts children at risk for developing malnutrition. Because of children's rapid periods of growth and development, early diagnosis, prevention, and management of malnutrition are paramount. The reasons for malnutrition in children with chronic disease are multifactorial and are related to the underlying disease and non-illness-associated factors. This review addresses the causes, evaluation, and management of malnutrition in pediatric congenital heart disease, chronic kidney disease, liver disease, and cystic fibrosis.
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Affiliation(s)
- Catherine Larson-Nath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Praveen Goday
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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11
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Einhorn LM, Taicher BM, Greene NH, Reinstein LJ, Jooste EH, Campbell MJ, Machovec KA. Percutaneous endoscopic gastrostomy vs surgical gastrostomy in infants with congenital heart disease. Paediatr Anaesth 2018; 28:612-617. [PMID: 29882315 DOI: 10.1111/pan.13416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants with congenital heart disease often require feeding tube placement to supplement oral intake. Gastrostomy tubes may be placed by either surgical or percutaneous endoscopic methods, but there is currently no data comparing outcomes of these procedures in this population. AIMS The aim of our retrospective study was to investigate the perioperative outcomes between the 2 groups to determine if there are clinically significant differences. METHODS We reviewed the charts of all infants with congenital heart disease at a single academic institution having isolated surgical or percutaneous endoscopic gastrostomy tube placement from January 2011 to December 2015. Anesthetic time, defined by cumulative minimum alveolar concentration hours of exposure to volatile anesthetic, was the primary outcome. Operative time, intraoperative complications, and postoperative intensive care admissions were secondary outcomes. RESULTS One hundred and one infants with congenital heart disease were included in this study. Anesthetic exposure was shorter in the endoscopic group than the surgical group (0.20 MAC-hours vs 0.56 MAC-hours, 95% confidence interval 0.23, 0.49, P < .001). Average operative times were also shorter in the endoscopic gastrostomy vs the surgical group (8 ± 0.7 minutes vs 35 ± 1.3 minutes, 95% confidence interval 23.7, 31.0, P < .001). Adjusting for prematurity and preoperative risk category, the surgical group was associated with a 3.45 fold increase in the likelihood of a higher level of care postoperatively (95% confidence interval 1.20, 9.90, P = .02). CONCLUSION In infants with congenital heart disease, percutaneous endoscopic gastrostomy placement is associated with reduced anesthetic exposure and fewer postoperative intensive care unit admissions compared to surgical gastrostomy.
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Affiliation(s)
- Lisa M Einhorn
- Pediatric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Brad M Taicher
- Pediatric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Nathaniel H Greene
- Pediatric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Leon J Reinstein
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Edmund H Jooste
- Pediatric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Michael J Campbell
- Division of Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kelly A Machovec
- Pediatric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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