Feeding Skills and Physiological Response to Feeding in Infants With Complex Congenital Heart Disease

PURPOSE: Complex congenital heart disease (CCHD) occurs in approximately 84 in 10,000 infants and commonly causes difficulties with feeding (Medoff-Cooper & Ravishankar, 2013; Reller, Strickland, Riehle-Colarusso, Mahle, & Correa, 2008). These feeding difficulties can be long-lasting, impacting overall development (Maurer et al., 2011). The purpose of this project was to characterize the feeding skills of infants with CCHD and to describe physiological response (oxygen saturation and heart rate) during feeding.

DESIGN: This descriptive study analyzed feedings delivered as part of usual care for 11 infants ≥36 wk gestational age (6 male, mean chronological age 10.3 days) admitted for treatment for CCHD. Potential participants were recruited via chart review.

METHOD: Feeding sessions were videotaped and scored by two raters using the Early Feeding Skills Assessment (EFS; Thoyre, Shaker, & Pridham, 2005). Heart rate and oxygen saturation (SpO₂) were recorded in 15-s increments for 30 min prior until 60 min after each feeding. Descriptive statistics and repeated-measures analysis of variance were used for analyses.

RESULTS: Results of the EFS coding indicate that average scores for the Oral Feeding Skills assessment sections all fell into the “some clinical concerns” range, while the scores of three individual participants fell into the “major clinical concerns” range. Almost half of the infants (44%) were not exhibiting readiness for feeding when the feeding began, and 55% scored low on feeding tolerance. Heart rate was significantly different across feedings, F (1.225, 12.251) = 14.287, p = .002, partial η² = .588. Post hoc analysis revealed a significant rise in heart rate from prefeeding (M = 140.923, SE = 3.002) to during feeding (M = 152.233, SE = 3.422; p < .001) and remained elevated postfeeding in eight of 11 infants.

Overall, average SpO₂ did not show significant variation across feeding, (F(2, 20) = .127, p = .881, partial η² = .013. However, the SpO₂ of two infants dipped into the 50s during feeding, which was greater than 20% below their mean baseline values. One of those infants, as well as two additional infants, experienced reductions postfeeding of greater than 20% below baseline (SpO₂ between 54% and 63%).

CONCLUSION: The results of this study suggest that infants with CCHD demonstrate feeding difficulties characterized primarily by physiological instability that continues for longer than 1 hr after the feeding is over. In contrast, the heart rate of healthy newborn infants returns to baseline within 5 min of the end of a feeding (Cohen, Brown, & Myers, 2001). Although these infants may demonstrate some signs of readiness to feed, many are fed even when not in an appropriate state for safe feeding.

Interventions to promote oral feeding in this population have not yet been developed. The impact of this project on the science of occupational therapy is that it provides data that is the first of its kind, which may lead to the development of interventions to support a population with lifelong challenges in occupational performance.

References

Cohen, M., Brown, D. R., & Myers, M. M. (2001). Cardiovascular responses to pacifier experience and feeding in newborn infants. Developmental Psychobiology, 39, 34–39. https://doi.org/10.1002/dev.1025

Maurer, I., Latal, B., Geissmann, H., Knirsch, W., Bauersfeld, U., & Balmer, C. (2011). Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease. Cardiology in the Young, 21, 303–309. https://doi.org/10.1017/S1047951110001976

Medoff-Cooper, B., & Ravishankar, C. (2013). Nutrition and growth in congenital heart disease: A challenge in children. Current Opinion in Cardiology, 28, 122–129. https://doi.org/10.1097/HCO.0b013e32835dd005

Reller, M. D., Strickland, M. J., Riehle-Colarusso, T., Mahle, W. T., & Correa, A. (2008). Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. Journal of Pediatrics, 153, 807–813. https://doi.org/10.1016/j.jpeds.2008.05.059

Thoyre, S. M., Shaker, C. S., & Pridham, K. F. (2005). The Early Feeding Skills Assessment for preterm infants. Neonatal Network, 24(3), 7–16. https://doi.org/10.1891/0730-0832.24.3.7