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Enteral access and reflux management in neonates with severe univentricular congenital heart disease: literature review and proposed algorithm

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Abstract

Neonates with severe congenital heart disease undergoing surgical repair may face various complications, including failure to thrive. Feeding tube placement and fundoplication are often performed to combat poor growth in neonates. With the variety of feeding tubes available and controversy surrounding when fundoplication is appropriate, there is no current protocol to determine which intervention is necessary for this patient population. We aim to provide an evidence-based feeding algorithm for this patient population. Initial searches for relevant publications yielded 696 publications; after review of these studies and inclusion of additional studies through external searches, a total of 38 studies were included for qualitative synthesis. Many of the studies utilized did not directly compare the different feeding modalities. Of the 38 studies included, five studies were randomized control trials, three studies were literature reviews, one study was an online survey, and the remaining twenty-nine studies were observational. There is no current evidence to suggest that this specific patient population should be treated differently regarding enteral feeding. We propose an algorithm to assist optimal feeding for neonates with congenital heart disease.

Conclusion: Nutrition remains a vital component of the care of neonates with congenital heart disease; determining the optimal feeding strategy for these patients can be approached like other neonates.

What is Known:

• Neonates with severe univentricular congenital heart disease often face failure to thrive.

• There is no consensus on feeding strategies for these patients.

What is New:

• We propose a feeding algorithm for neonates with severe univentricular congenital heart disease.

• Feeding strategies can be similar to that of other neonates.

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Authors and Affiliations

  1. Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA

    Vardhan Avasarala, Varun Aitharaju & Todd A. Ponsky

  2. Department of Pediatric Surgery, Akron Children’s Hospital, 215 West Bowery Street, Level 6, Akron, OH, 44308, USA

    Ellen M. Encisco, Todd A. Ponsky & Justin T. Huntington

  3. Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Ellen M. Encisco, Beth Rymeski & Todd A. Ponsky

Authors
  1. Vardhan Avasarala
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  2. Varun Aitharaju
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  5. Todd A. Ponsky
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Contributions

All authors contributed to the study’s conception and manuscript writing. All authors were involved in the literature search and data analysis. Vardhan Avasarala and Varun Aitharaju were involved in editing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Justin T. Huntington.

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This is a review study. Ethical approval was not necessary for this review. This research does not involve animals.

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Communicated by Daniele De Luca

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Avasarala, V., Aitharaju, V., Encisco, E.M. et al. Enteral access and reflux management in neonates with severe univentricular congenital heart disease: literature review and proposed algorithm. Eur J Pediatr 182, 3375–3383 (2023). https://doi.org/10.1007/s00431-023-04992-4

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