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Background: Infants with critical congenital heart disease (cCHD) are at risk for requiring supplemental enteral nutrition or tube feedings (TF). We sought to determine clinical characteristics associated with requirement for nasogastric or gastric tube feedings at neonatal discharge following surgery for cCHD.

Methods: We retrospectively reviewed data from all newborns with cCHD requiring cardiac surgery within the first 30 days of life (n=377) from our tertiary children’s hospital (CH) from January 2008 to March 2013. Descriptive statistics PO vs. TF comparisons using a univariate analysis were completed. Multivariable logistic regression with variable receiver operating characteristics (ROC) curve comparisons were used to determine the association between patient characteristics and requirement for TF at discharge. Patients who did not survive to discharge were excluded from this secondary analysis.

Results: Of 339 neonates, 122 (36%) were discharged with TF (67 PO+NG, 19 PO+GT, 36 GT). Univariate analysis: when compared to those that were fed orally, TF infants had similar prenatal detection (37.7% vs 42.4%, p=0.40), single ventricle palliation (37.7% vs 37.8%, p=0.99), and STAT scores (69.5% STAT ≥ 4 vs 66.8%, p=0.37). In contrast, lower incidence of pre-operative feedings (62.3% vs 73.3%, p=0.04), higher rate of sepsis (23.8% vs 8.8%, p < 0.001), and higher rate of necrotizing enterocolitis (NEC) (15.6% vs 4.1%, p < 0.001) were noted with TF infants. After multivariable adjustment, no associations persisted between TF and pre-operative feeding, sepsis, or NEC. The odds of TF increased with distance from the CH and birth hospital [estimate 1.07 per 20 mile distance from CH; 95% confidence interval (CI) 1.016, 1.129, p=0.01] or increase of 7% risk TF for every 20 miles. The odds of TF increased with 2 or more subspecialty consults [Odds Ratio (OR) 3.18; 95% CI 1.75, 5.78, p < 0.001] and major genetic abnormalities (OR 2.82, 95% CI 1.28, 6.39, p=0.01). Delays in post-operative feedings were associated with higher likelihood of need for enteral nutrition (estimate 1.12; 95% CI 1.05, 1.20, p < 0.001), indicating a 12% increase for each day delay in post-surgical feeding.

Conclusions: Infants with cCHD that deliver farther from the children’s hospital, have multiple subspecialty consults, genetic abnormalities, and delays in post-operative feeds are associated with a greater likelihood for tube feeds at hospital discharge. A probability model was fit to this current data set. This model will continue to be tested and validated to predict tube feedings in new patients.

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Association of Enteral Tube Feedings at Discharge for Neonates with Critical Congenital Heart Disease