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.
摘要：
需要进行先天性心脏病（CHD）手术的新生儿在术后经常难以口服喂食，并且在出院时可能需要喂食管。这项研究的目的是确定口腔或鼻插管途径对出院时喂养方法的影响。这是一项针对2018年至2021年间接受冠心病手术的62例新生儿的非盲随机对照试验。鼻部（25例）和口腔（37例）组的婴儿在喂养困难的术前风险因素方面相似，包括出生时完成孕周（39vs38周），出生体重（3530vs3100克），术前PO摄入量（92%vs81%），术前插管率（22％vs28％）。手术风险因素也相似，包括胸外科医师协会-欧洲心胸外科协会类别（3.9vs4.1），分流安置（32%对41%），体外循环时间（181vs177分钟），和交叉钳制时间（111对105分钟）。96％的鼻插管患者通过出院完全口服喂养，而78％的口服插管婴儿（p=0.05）。经鼻插管的婴儿比经口插管的婴儿平均提前3天达到完全经口喂养。在这群患者中，与经口插管的同龄人相比，经鼻插管的婴儿更快达到经口喂养，并且不太可能需要补充管喂养。插管途径是口腔厌恶的潜在可改变的危险因素，在新生儿中似乎是安全的。该研究获得了弗吉尼亚大学健康科学研究机构审查委员会的批准，并于2022年5月18日在clinicaltrials.gov（NCT05378685）上进行了回顾性注册。
