In our neonatal/pediatric population, often the need for TEE (Trans Esophageal ECHO), a the surgical procedure that involved the aortic arch, and/or both intra-operative and post-operative events —in the setting of the inherent neurodevelopmental risks for the CHD population — all raise our index of suspicion when we are re-consulted post-op.
I have been meaning to post this article by the team at CHOP for my peds colleagues who follow our infants/children with CHD. It suggests the most common risk factors associated with poor feeding for infants with Congenital Heart Disease at time of discharge were: birth weight (36% of included studies), gestational age (44%), duration of post-operative intubation (48%), cardiac diagnosis (40%), and presence of genetic syndrome or chromosomal anomaly (36%).
Jacobwitz M, Dean Durning J,Moriarty H, James R, Irving SY, Licht DJ, and Yost J (2023) Oral feeding dysfunction in post-operative infants with CHDs: a scoping review.Cardiology in the Young 33: 570–578.doi: 10.1017/S1047951122001299
While pre-operatively the presence of complex co-morbidities portends for more worrisome post-op feeding challenges, in this population the well-intentioned “push” to PO feed or the “push” to return to PO feeding post-op in a regimented way, often sets the stage for volume-driven stressful feeding experiences (for infants and children alike). That can then often provoke the onset of feeding refusals and indeed aversions, and further exacerbate baseline risk for enduring feeding problems. Our partnership with the PCVICU team, including families, is so important to optimize feeding outcomes in this at risk population and support joy in feeding for a lifetime.
I hope this informs your practice as it did mine.