Article

Feeding Complications in Hypoplastic Left Heart Syndrome After the Norwood Procedure: A Systematic Review of the Literature

University of Michigan Medical School, 1301 Catherine Road, Ann Arbor, MI 48109-5864, USA.
Pediatric Cardiology (Impact Factor: 1.55). 02/2011; 32(4):539-52. DOI: 10.1007/s00246-011-9907-x
Source: PubMed

ABSTRACT Gastrointestinal and feeding complications after the Norwood procedure in infants with hypoplastic left heart syndrome increases morbidity and mortality. These problems are the result of intraoperative challenges, shunt-dependent physiology, and the absence of best-practice guidelines. In response, a systematic review of feeding-related complications and management strategies was performed. A literature search from 1950 to March 2010 identified 21 primary research articles and 4 reviews. Dysphagia, necrotizing enterocolitis (NEC), and poor nutritional status are significant feeding-related complications. Three studies directly compared the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit (RV-PA). Patients palliated with either shunt had impaired mesenteric blood flow. Mortality did not differ between shunt types. Three studies demonstrated improved outcomes, e.g., increased survival, decreased incidence of NEC, and decreased median time to recommended daily allowance of calories, with a postoperative feeding algorithm. Two studies showed increased survival between stage I and II surgical palliation after implementation of a home-monitoring system consisting of daily weight and systemic oxygen saturation measurements. The RV-PA shunt does not significantly alter mortality or increase mesenteric blood flow. A postoperative feeding algorithm and a home-monitoring system may improve outcomes and decrease average hospital length of stay (LOS). Additional studies are needed to determine which interventions, as part of a standardized protocol, improve survival and decrease complications.

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    • "This may be due to factors related to cardiopulmonary bypass effects and reduced risk for recurrent laryngeal nerve damage that is more likely to occur in the Norwood than in the shunt/ hybrid procedure. Recent studies have found that shunt-type and hybrid surgical approach do not lessen any of the risk factors seen in the patients undergoing the Norwood procedure with cardiopulmonary bypass or result in significant differences in overall hospital length of stay (Golbus et al., 2011; Luce et al., 2011). "
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