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Impact of Preoperative Enteral Feeding on Perioperative Outcomes in Patients with Hypoplastic Left Heart Syndrome
Christopher D Derby, Dore Klenk, Christian Pizarro
Alfred I duPont Hospital for Children, Wilmington, DE
Objective:
The lack of supportive data regarding the optimal preoperative management strategy for infants with HLHS has led to significant variation in the management of these patients prior to surgery. Gastrointestinal and feeding difficulties frequently complicate the postoperative course of these patients. Our purpose was to identify the incidence of these complications and determine what impact a strategy of preoperative enteral feeding had on perioperative morbidity and the ability to feed by mouth postoperatively.
Methods:
We reviewed the hospital course of 42 consecutive patients with HLHS who underwent surgical palliation over the previous 6 years. Twelve patients were considered high risk due to extreme prematurity and low birth weight and/or considerable cardiac and non-cardiac comorbidities and were excluded from analysis.
Results:
Of 30 patients, 15 were fed enterally preoperatively and 15 were kept NPO according to individual surgeon preference. There were no differences in gestational age, weight or age at surgery, or associated comorbidities including preoperative mechanical ventilation between the two groups. Overall survival was 90% (27/30). There were no deaths related to enteral complications. No patients experienced NEC. 93% (14/15) of patients fed enterally before surgery were discharged home on oral feeds. 83% (10/12) of patients NPO before surgery had difficulty feeding postoperatively and required tube feeds at discharge. By univariate analysis, patients fed enterally prior to surgery had shorter mechanical ventilation times (p 0.0003) and fewer postoperative complications (p 0.01). In a logistic regression model, preoperative enteral feeding predicted oral feeding at discharge (OR 77.3, p 0.006) and was associated with a shorter hospital length of stay (p 0.05).
Conclusion:
In patients with HLHS not considered “high risk”, a strategy of preoperative enteral feeding is safe and is associated with improved perioperative outcomes including the ability to meet full nutritional demands by mouth at discharge. Further follow-up is indicated to determine whether such a strategy sustains appropriate interim growth and/or impacts interim mortality.
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