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The prevalence and effects of aspiration among neonates at the time of discharge

Published online by Cambridge University Press:  06 February 2017

Emily Karsch ,
Sharon Y. Irving ,
Brandon S. Aylward  and
William T. Mahle
Emily Karsch
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Sharon Y. Irving
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America Department of Nursing, Respiratory Care and Neurodiagnostic Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Brandon S. Aylward
Affiliation:
Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States of America
William T. Mahle*
Affiliation:
Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States of America
*
Correspondence to: W. T. Mahle, MD, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322-1062, United States of America. Tel: +404 785 1672; Fax: 404 785 6021; E-mail: [email protected]
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Abstract

Background

Neonates undergoing heart surgery for CHD are at risk for postoperative gastrointestinal complications and aspiration events. There are limited data regarding the prevalence of aspiration after neonatal cardiothoracic surgery; thus, the effects of aspiration events on this patient population are not well understood. This retrospective chart review examined the prevalence and effects of aspiration among neonates who had undergone cardiac surgery at the time of their discharge.

Introduction

This study examined the prevalence of aspiration among neonates who had undergone cardiac surgery. Demographic data regarding these patients were analysed in order to determine risk factors for postoperative aspiration. Post-discharge feeding routes and therapeutic interventions were extracted to examine the time spent using alternate feeding routes because of aspiration risk or poor caloric intake. Modified barium swallow study results were used to evaluate the effectiveness of the test as a diagnostic tool.

Materials and methods

A retrospective study was undertaken of neonates who had undergone heart surgery from July, 2013 to January, 2014. Data describing patient demographics, feeding methods, and follow-up visits were recorded and compared using a χ2 test for goodness of fit and a Kaplan–Meier graph.

Results

The patient population included 62 infants – 36 of whom were male, and 10 who were born with single-ventricle circulation. The median age at surgery was 6 days (interquartile range=4 to 10 days). Modified barium swallow study results showed that 46% of patients (n=29) aspirated or were at risk for aspiration, as indicated by laryngeal penetration. In addition, 48% (n=10) of subjects with a negative barium swallow or no swallow study demonstrated clinical aspiration events. Tube feedings were required by 66% (n=41) of the participants. The median time spent on tube feeds, whether in combination with oral feeds or exclusive use of a nasogastric or gastric tube, was 54 days; 44% (n=27) of patients received tube feedings for more than 120 days. Premature infants were significantly more likely to have aspiration events than infants delivered at full gestational age (OR p=0.002). Infants with single-ventricle circulation spent a longer time on tube feeds (median=95 days) than infants with two-ventricle defects (median=44 days); the type of cardiac defect was independent of prevalence of an aspiration event.

Conclusions

Aspiration is common following neonatal cardiac surgery. The modified barium swallow study is often used to identify aspiration events and to determine an infant’s risk for aspirating. This leads to a high proportion of infants who require tube feedings following neonatal cardiac surgery.

Keywords

Aspirationneonatecardiothoracic surgerymodified barium swallow studytube feedsCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1241 - 1247
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Copyright
© Cambridge University Press 2017 

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