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The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial

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Abstract

Neonates who require surgery for congenital heart disease (CHD) frequently have difficulty with oral feeds post-operatively and may require a feeding tube at hospital discharge. The purpose of this study was to determine the effect of oral or nasal intubation route on feeding method at hospital discharge. This was a non-blinded randomized control trial of 62 neonates who underwent surgery for CHD between 2018 and 2021. Infants in the nasal (25 patients) and oral (37 patients) groups were similar in terms of pre-operative risk factors for feeding difficulties including completed weeks of gestational age at birth (39 vs 38 weeks), birthweight (3530 vs 3100 g), pre-operative PO intake (92% vs 81%), and rate of pre-operative intubation (22% vs 28%). Surgical risk factors were also similar including Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category (3.9 vs 4.1), shunt placement (32% vs 41%), cardiopulmonary bypass time (181 vs 177 min), and cross-clamp time (111 vs 105 min). 96% of nasally intubated patients took full oral feeds by discharge as compared with 78% of orally intubated infants (p = 0.05). Nasally intubated infants reach full oral feeds an average of 3 days earlier than their orally intubated peers. In this cohort of patients, nasally intubated infants reach oral feeds more quickly and are less likely to require supplemental tube feeding in comparison to orally intubated peers. Intubation route is a potential modifiable risk factor for oral aversion and appears safe in neonates. The study was approved by the University of Virginia Institutional Review Board for Health Sciences Research and was retrospectively registered on clinicaltrials.gov (NCT05378685) on May 18, 2022.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Melissa I. Yildirim

  2. Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA

    Michael C. Spaeder & Deborah U. Frank

  3. Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Barbara A. Castro, Sarah Howard, Peggy McNaull, Jacob Raphael, Ruchik Sharma, Samantha Vizzini & Amy Wielar

  4. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA

    Rebecca Chamberlain & Lisa Fuzy

  5. Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Jacob Raphael

Authors
  1. Melissa I. Yildirim
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  2. Michael C. Spaeder
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  3. Barbara A. Castro
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  4. Rebecca Chamberlain
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  5. Lisa Fuzy
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  6. Sarah Howard
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  7. Peggy McNaull
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  8. Jacob Raphael
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  9. Ruchik Sharma
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  10. Samantha Vizzini
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  11. Amy Wielar
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  12. Deborah U. Frank
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Contributions

MY and DF: designed and led the study including subject recruitment and randomization, data collection, analysis, and drafting of the manuscript. MS: performed statistical analysis and contributed to drafting and editing of the manuscript, particularly the introduction and discussion. RC and LF: helped with study design and were essential to subject recruitment. BC, SH, PM, JR, RS, SV, AW: performed all intubations and contributed to safety observations and discussion. All authors reviewed and approved the manuscript.

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Correspondence to Melissa I. Yildirim.

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Yildirim, M.I., Spaeder, M.C., Castro, B.A. et al. The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial. Pediatr Cardiol 45, 426–432 (2024). https://doi.org/10.1007/s00246-023-03322-7

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  • DOI: https://doi.org/10.1007/s00246-023-03322-7

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