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Risk Factors for Tube Feeding at Discharge in Infants Undergoing Neonatal Surgery for Congenital Heart Disease: A Systematic Review

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Abstract

Approximately 30–50% of infants undergoing neonatal surgery for congenital heart disease (CHD) cannot meet oral feeding goals by discharge and require feeding tube support at home. Feeding tubes are associated with increased readmission rates and consequent hospital, payer, and family costs, and are a burden for family caregivers. Identification of modifiable risk factors for oral feeding problems could support targeted care for at-risk infants. Therefore, the aim of this systematic review is to determine risk factors for tube feeding at discharge in infants undergoing neonatal surgery for CHD. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. Studies published before 2010 were excluded. The search resulted in 607 records, of which 18 were included. Studies were primarily retrospective cohort designs and results were often inconsistent. Study quality was assessed using the Joanna Briggs Critical Appraisal Tools. As a group, the studies exhibited substantial risk for bias. Based on the findings, infants who struggle with feeding preoperatively, experience increased nil per os duration and/or low oral feeding volume postoperatively, experience increased duration of mechanical ventilation, or have vocal cord dysfunction may be at risk for tube feeding at hospital discharge. Factors warranting further examination include cardiac physiology (e.g., aortic arch obstruction) and the relationship between neurodevelopment and oral feeding. Clinicians should use caution in assuming risk for an individual and prioritize early implementation of interventions that facilitate oral feeding development.

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Acknowledgements

The authors wish to acknowledge Liz Weinfurter, MLIS, Associate Librarian, Health Sciences Library, University of Minnesota, for her assistance with the search.

Funding

This research did not receive any funding or financial support.

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Authors and Affiliations

  1. University of Minnesota School of Nursing, Minneapolis, MN, USA

    Kristin M. Elgersma, Anna L. Trebilcock, Mary O. Whipple, Lynn R. Tanner, Sarah J. Pilditch & Anne Chevalier McKechnie

  2. Children’s Minnesota, Minneapolis, MN, USA

    Lynn R. Tanner

  3. Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA

    Kavisha M. Shah

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  1. Kristin M. Elgersma
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KME and ACM formulated the review question. KME and ALT performed the literature search and study selection; KME and SJP performed data extraction; KME, MOW, LRT, and ACM assessed the quality of the included studies. KME drafted the manuscript. All authors revised, reviewed, and approved the final manuscript.

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Correspondence to Kristin M. Elgersma.

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Elgersma, K.M., Trebilcock, A.L., Whipple, M.O. et al. Risk Factors for Tube Feeding at Discharge in Infants Undergoing Neonatal Surgery for Congenital Heart Disease: A Systematic Review. Pediatr Cardiol 44, 769–794 (2023). https://doi.org/10.1007/s00246-022-03049-x

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