Preoperative oral feeding may improve outcomes for single-ventricle anomaly infants

Giving infants a chance to start developing oral feeding motor skills before surgery may be a modifiable risk factor for postoperative feeding tube dependence.

In babies with single-ventricle anomalies, triggering their oral feeding motor skills in the first hours or days of life before their first surgery may reduce dependence on feeding tubes and lead to better outcomes.

“Preoperative oral feeding may be a modifiable risk factor that can decrease time of postoperative feeding tube dependence,” Joshua Kurtz, M.D., a pediatric cardiologist at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, said during a recent Pediatric Grand Rounds.

“Feeding dysfunction is a common problem in single-ventricle heart disease and requires multiple specialties for the best outcomes,” Dr. Kurtz said. “Exclusive oral feeding decreases resource utilization, is associated with better neurodevelopmental outcomes, and is associated with decreased mortality”

Standardized feeding protocols can be used safely to increase the rate of oral feeding while minimizing risks of necrotizing enterocolitis (NEC) , according to Dr. Kurtz.

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Dr. Kurtz, who joined Norton Children’s Heart Institute in 2020, studied infants with single ventricle defect’s ability to transition to oral feeding while completing his fellowship in pediatric cardiology at the Medical University of South Carolina in Charleston.

His study, Factors Associated With Delayed Transition to Oral Feeding in Infants with Single Ventricle Physiology, published in The Journal of Pediatrics, found that infants who were able to transition off a gastronomy tube sooner were more likely to have fed orally before their stage 1 operation, had a greater weight-to-age Z score at their first discharge, spent less time in intensive care, were discharged sooner overall, and had a better weight-to-age Z score when they returned for the Glenn procedure.

Physicians are often hesitant to feed these patients pre-operatively, as the infants are receiving vasoactive medications and prostaglandin for systemic or pulmonary-dependent ductal blood flow and have decreased cardiac output and unbalanced circulation. All these conditions put babies at risk for NEC.

“Increasingly, however, studies are showing that oral feeding at this stage can be done safely with minimal increased risk of adverse events, especially related to the mesenteric system and NEC,” Dr. Kurtz said.

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