The Impact of Neurobehavior on Feeding Outcomes in Neonates with Congenital Heart Disease.
The Impact of Neurobehavior on Feeding Outcomes in Neonates with Congenital Heart Disease.
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神经行为对先天性心脏病新生儿喂养结果的影响。
DOI：
10.1016/j.jpeds.2019.06.047
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Miller,Thomas
中科院分区：
文献类型：
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作者：
Gakenheimer-Smith,Lindsey;Glotzbach,Kristi;Ou,Zhining;Presson,AngelaP;Puchalski,Michael;Jones,Courtney;Lambert,Linda;Delgado-Corcoran,Claudia;Eckhauser,Aaron;Miller,Thomas
目的评估先天性心脏病 (CHD) 手术后新生儿神经行为状态与经口喂养结果之间的关联。研究设计这项单中心回顾性队列研究描述了接受心脏手术的新生儿在围术期使用新生儿重症监护病房网络神经行为量表 (NNNS) 进行评估。我们使用回归分析将 NNNS 注意力评分（评估新生儿定向和注视刺激的能力）与出院时口服喂养的喂养结果百分比以及达到完全口服喂养的时间进行了比较。构建术前和术后 NNNS 评估模型。结果 2015 年 8 月至 2017 年 10 月，124 名新生儿接受了 89 次术前和 97 次术后 NNNS 评估。在多变量 Cox 回归中，较高的术前 NNNS 注意力评分与实现完全经口喂养的时间较短相关（风险比 1.4；95% CI 1.0-2.0；P= .047）。术后 NNNS 注意力评分或出院时经口进食的百分比并未发现这种关系。根据模型的不同，手术年龄较小、呼吸机使用天数增加、住院时间增加以及主动脉弓梗阻的单心室或二心室解剖结构与出院时经口喂养百分比较低和/或完全经口喂养延迟相关。 结论 心脏手术前新生儿注意力较高与喂养结果改善相关。新生儿神经行为状态的前瞻性评估可能是预测和针对性干预措施以改善先心病喂养结果的一种新方法。未来的研究应该探讨内在神经发育迟缓与环境适应对先心病新生儿神经行为状态的影响。
ObjectiveTo evaluate the association between neonatal neurobehavioral state and oral feeding outcomes following congenital heart disease (CHD) surgery.Study designThis single center retrospective cohort study described neonates undergoing cardiac surgery evaluated perioperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). We compared NNNS attention scores, which evaluates neonates' ability to orient and fixate on stimuli, with the feeding outcomes percentage of feeds taken orally at discharge and time to reach full oral feeds using regression analyses. Models were constructed for both preoperative and postoperative NNNS evaluations.ResultsBetween August 2015 and October 2017, 124 neonates underwent 89 preoperative and 97 postoperative NNNS evaluations. In multivariable Cox regression, higher preoperative NNNS attention scores were associated with a shorter time to achieve full oral feeds (hazard ratio 1.4; 95% CI 1.0‒2.0;P= .047). This relationship was not seen for post-operative NNNS attention scores or percentage of oral feeds at discharge. Depending on the model, younger age at surgery, increased ventilator days, increased length of stay, and single or 2-ventricle anatomy with aortic arch obstruction were associated with lower percentage of oral feeds at discharge and/or delay in full oral feeds.ConclusionsHigher neonatal attention before cardiac surgery is associated with improved feeding outcomes. Prospective assessment of neonatal neurobehavioral state may be a novel approach to predict and target interventions to improve feeding outcomes in CHD. Future studies should examine the impact of intrinsic neurodevelopmental delay vs environmental adaptation on the neurobehavioral state of neonates with CHD.