Enteral Access in Pediatric Cardiac Patients: A Survey of Pediatric Surgeons at the Top 50 Cardiac Hospitals.

PURPOSE: Maintaining the nutritional status of pediatric cardiac patients is essential as these children often have higher metabolic needs and predilection for feeding difficulties. Despite the importance in preventing malnutrition in these patients, there remains a lack of consensus in management. We surveyed pediatric surgeons at top pediatric cardiac hospitals to query their practices in enteral access for infants with cardiac disease.

METHODS

We utilized the US News & World Report rankings to identify the top rated 50 "Pediatric Cardiac" hospitals and surveyed pediatric surgeons at each identified institution. The survey included questions regarding initial preoperative workup, stakeholders in management, and practice patterns regarding gastrostomy tubes (GTs), Nissen fundoplications, and gastrojejunostomy tubes (GJTs).

RESULTS

Of the 505 pediatric surgeons surveyed, 116 responded for a 30.0 % response rate, including representation from all 50 institutions. 34 (29.6 %) participants reported that a formal protocol existed at their institution for management of enteral feeding access in pediatric cardiac patients. The utilization of Nissen fundoplications varied widely. For patients with non-single or single ventricle physiology, 63.7 % and 72.8 % of survey respondents reported never or rarely performing Nissen fundoplications, respectively. In contrast, 62.5 % and 61.1 % of survey respondents sometimes, frequently, or always perform a primary GJT or GT with plan for GJ conversion for patients with either non-single or single ventricle physiology, respectively.

CONCLUSIONS

Despite the importance of nutrition in cardiac patients, practice patterns among pediatric surgeons in managing enteral access are variable. Further evidence is needed to determine what enteral access benefits patients most given the current discrepancies.

LEVEL OF EVIDENCE: IV.