The Impact of Neurobehavior on Feeding Outcomes in Neonates with Congenital Heart Disease

• Published in: The Journal of pediatrics Vol. 214; pp. 71 - 78.e2
• Main Authors: Gakenheimer-Smith, Lindsey, Glotzbach, Kristi, Ou, Zhining, Presson, Angela P., Puchalski, Michael, Jones, Courtney, Lambert, Linda, Delgado-Corcoran, Claudia, Eckhauser, Aaron, Miller, Thomas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2019
• Subjects: Attention; congenital heart disease; Feeding Behavior - psychology; Female; Follow-Up Studies; Heart Defects, Congenital - psychology; Heart Defects, Congenital - surgery; Humans; Infant Behavior - psychology; Infant, Newborn; Male; neurodevelopment; Neuropsychological Tests; oral feeding; Postoperative Period; Preoperative Period; Retrospective Studies; LOS; NNNS; neurodevelopment; congenital heart disease; oral feeding; HR; MI; CHD
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2019.06.047

To evaluate the association between neonatal neurobehavioral state and oral feeding outcomes following congenital heart disease (CHD) surgery.
This single center retrospective cohort study described neonates undergoing cardiac surgery evaluated perioperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). We compared NNNS attention scores, which evaluates neonates' ability to orient and fixate on stimuli, with the feeding outcomes percentage of feeds taken orally at discharge and time to reach full oral feeds using regression analyses. Models were constructed for both preoperative and postoperative NNNS evaluations.
Between August 2015 and October 2017, 124 neonates underwent 89 preoperative and 97 postoperative NNNS evaluations. In multivariable Cox regression, higher preoperative NNNS attention scores were associated with a shorter time to achieve full oral feeds (hazard ratio 1.4; 95% CI 1.0‒2.0; P = .047). This relationship was not seen for post-operative NNNS attention scores or percentage of oral feeds at discharge. Depending on the model, younger age at surgery, increased ventilator days, increased length of stay, and single or 2-ventricle anatomy with aortic arch obstruction were associated with lower percentage of oral feeds at discharge and/or delay in full oral feeds.
Higher neonatal attention before cardiac surgery is associated with improved feeding outcomes. Prospective assessment of neonatal neurobehavioral state may be a novel approach to predict and target interventions to improve feeding outcomes in CHD. Future studies should examine the impact of intrinsic neurodevelopmental delay vs environmental adaptation on the neurobehavioral state of neonates with CHD.