Gastrostomy Tube Feeding after Neonatal Complex Cardiac Surgery Identifies the Need for Early Developmental Intervention

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• 作者：M. Florencia Ricci ; MD¹ ; Gwen Y. Alton ; MN² ; David B. Ross ; MD³ ; Bryan J. Dicken ; MD⁴ ; Diane M. Moddemann ; MD⁵ ; Charlene M.T. Robertson ; MD¹ ; ² ; ^{Charlene.Robertson@albertahealthservices.ca" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Western Canadian Complex Pediatric Therapies Follow-up Group^&lowast ; ; Ivan M. Rebeyka ; MD ; Gonzalo Garcia Guerra ; MD ; Joseph Atallah ; MD ; MSc ; Irena A. Dinu ; PhD ; Patricia Blakley ; MD ; Jay Bodani ; MD ; Anne Synnes ; MDCM ; MSc
• 关键词：ABAS-II ; Adaptive Behavior Assessment System-Second Edition ; Bayley-III ; Bayley Scales of Infant and Toddler Development-Third Edition ; BSID-II ; Bayley Scales of Infant Development-Second Edition ; CCS ; Complex cardiac surgery ; CHD ; Congenital heart disease ; EDI ; Early developmental intervention ; GTF ; Gastrostomy tube feeding
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：169
• 期：Complete
• 页码：160-165.e1
• 全文大小：330 K

文摘

To compare the proportion of developmental delay in early complex cardiac surgery (CCS) survivors with and without gastrostomy tube feeding (GTF). To explore acute care predictors of GTF that might help improve care in CCS survivors.

Study group

This comparison study of 2 groups within an inception cohort included 334 CCS survivors after cardiopulmonary bypass at ≤6 weeks of age (2005-2012) who did not require extracorporeal membrane oxygenation or heart transplantation. Children were assessed at 21 ± 3 months with the Bayley Scales of Infant and Toddler Development-Third Edition and the Adaptive Behavior Assessment System-Second Edition: general adaptive composite score. Delay was determined by scores >2 SD below mean. The χ² test compared groups. Predictors of GTF were analyzed using multiple logistic regression analysis, results expressed as OR with 95% CI.

Results

Of the survivors, 67/334 (20%) had GTF any time before the 21-month assessment. Developmental delays in children with GTF were cognitive in 16 (24%), motor in 18 (27%), language in 24 (36%) vs without GTF in 7 (3%), 8 (3%), and 32 (12%), respectively (P < .001). Gastrostomy group had almost 8 times the number of children delayed on the general adaptive composite score. Independent OR for GTF are presence of a chromosomal abnormality, OR 4.6 (95% CI 1.8, 12.0) (P = .002), single ventricle anatomy, OR 3.4 (95% CI 1.7, 6.8) (P < .001), total postoperative days of open sternum, OR 1.15 (95% CI 1.1, 1.3) (P = .031), and total number of hospital days at CCS, OR 1.03 (95% CI 1.1, 1.04) (P = .002).

Conclusions

GTF identifies CCS survivors at risk for delay, who would benefit from early developmental intervention. The described mostly nonmodifiable predictors may guide counseling of these children's families.