Abstract 4365207: Risk Factors for and Outcomes Following Tube Assisted Feeding in Neonates Undergoing Cardiac Surgery

Abstract

Introduction: Feeding difficulties are common following neonatal surgery for congenital heart disease (CHD) and often lead to tube assisted feeding (TAF), defined as feeding via enteral tube, alone or in combination with oral feeding. TAF places a burden on families and healthcare resources and may serve as a barrier to normal infant development. Risk factors for TAF in the CHD population are poorly defined. Our primary aim was to identify patient characteristics and clinical outcomes associated with TAF at hospital discharge in neonates after cardiac surgery. Methods: This was a multicenter retrospective analysis of infants with CHD and an index neonatal cardiac operation at ≤30 days of age who survived to hospital discharge. Data included all acute care cardiology unit (ACCU) and cardiac intensive care unit (CICU) encounters sourced from the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium databases 2/2019-12/2023. Patients with tracheostomy were excluded. Comparative statistics were used to evaluate factors associated with exclusive oral feeding versus TAF at discharge. Results: Among 5,541 encounters (5,538 patients) from 34 centers, 58% were discharged with TAF. TAF patient characteristics included female sex, prematurity, genetic abnormalities (p<0.0001 for all) and non-Hispanic ethnicity (p=0.009), Table 1. These patients had higher index operation STAT category and maximal vasoactive inotropic score, longer chest open and postoperative ventilator days, and more postoperative oral reintubations (p<0.0001 for all). They were fed preoperatively less and postoperative feeds were initiated later (p<0.0001 for all). TAF patients had longer CICU and ACCU length of stay and higher ACCU readmission rate (p<0.0001 for all). Patients in the Southern region had higher rates of exclusive oral feeding (p<0.0001). Conclusion: In this large multi-institutional cohort, more than 50% of infants were discharged with TAF after neonatal cardiac surgery. Postoperative reintubation, ventilator days, and timing of preoperative and postoperative oral feeding were identified as independent risk factors for TAF. These could be targets for development of a multivariable model to identify variables that may predict which patients require TAF, aiding in both counseling for families and resource utilization.