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. 2023 Mar;165(3):1248-1256.
doi: 10.1016/j.jtcvs.2022.04.044. Epub 2022 May 16.

Cardiovascular intensive care unit variables inform need for feeding tube utilization in infants with hypoplastic left heart syndrome

Caitlin Milligan  1 , Kimberly I Mills  2 , Shirley Ge  3 , Anna Michalowski  4 , Nancy Braudis  5 , Laura Mansfield  6 , Meena Nathan  7 , Lynn A Sleeper  6 , Sarah A Teele  2
Affiliations

Cardiovascular intensive care unit variables inform need for feeding tube utilization in infants with hypoplastic left heart syndrome

Caitlin Milligan et al. J Thorac Cardiovasc Surg. 2023 Mar.

Abstract

Objective: Feeding strategies in infants with hypoplastic left heart syndrome (HLHS) following stage 1 palliation (S1P) include feeding tube utilization (FTU). Timely identification of infants who will fail oral feeding could mitigate morbidity in this vulnerable population. We aimed to develop a novel clinical risk prediction score for FTU.

Methods: This was a retrospective study of infants with HLHS admitted to the Boston Children's Hospital cardiovascular intensive care unit for S1P from 2009 to 2019. Infants discharged with feeding tubes were compared with those on full oral feeds. Variables from early (birth to surgery), mid (postsurgery to cardiovascular intensive care unit transfer), and late (inpatient transfer to discharge) hospitalization were analyzed in univariate and multivariable models.

Results: Of 180 infants, 66 (36.7%) discharged with a feeding tube. In univariate analyses, presence of a genetic disorder (early variable, odds ratio, 3.25; P = .014) and nearly all mid and late variables were associated with FTU. In the mid multivariable model, abnormal head imaging, ventilation duration, and vocal cord dysfunction were independent predictors of FTU (c-statistic 0.87). Addition of late variables minimally improved the model (c-statistic 0.91). A risk score (the HV2 score) for FTU was developed based on the mid multivariable model with high specificity (93%).

Conclusions: Abnormal head imaging, duration of ventilation, and presence of vocal cord dysfunction were associated with FTU in infants with HLHS following S1P. The predictive HV2 risk score supports routine perioperative head imaging and vocal cord evaluation. Future application of the HV2 score may improve nutritional morbidity and hospital length of stay in this population.

Keywords: G-tube; cardiovascular intensive care unit; congenital heart defects; feeding tube; hypoplastic left heart syndrome (HLHS); vocal cord dysfunction.

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Conflict of interest statement

Conflict of Interest Statement

The authors reported no conflicts of interest.

The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
HV2 score for feeding tube utilization. A, Distribution of HV2 scores (from 0 to 20) for patients who received a feeding tube during admission (right) and those who did not (left). B, Estimated probability of feeding tube utilization according to HV2 score, with pointwise 95% confidence bands. Dashed vertical lines represents cutoffs for “high-risk” with a cut-off score of 12 giving a high specificity (93%) and a cutoff of 4 giving a high sensitivity (100%). HV2, Head imaging, ventilation duration, vocal cord dysfunction.
FIGURE 2.
FIGURE 2.
Risk factors for feeding tube utilization in infants with hypoplastic left heart syndrome (HLHS): Infants with HLHS admitted for stage 1 palliation (S1P) were compared by feeding tube utilization (FTU) at discharge. Mid hospitalization variables (from surgery through cardiovascular intensive care unit [CICU] transfer) were highly associated with FTU and were used to create the HV2 (Head imaging, Ventilation duration, Vocal cord dysfunction) score. Greater HV2 scores were associated with greater probability of FTU. HV2, Head imaging, ventilation duration, vocal cord dysfunction.
None
Probability of feeding tube utilization according to HV2 score.
See this image and copyright information in PMC

Comment in

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