Association between pediatric feeding disorders (PFD) and suboptimal neurodevelopment (SND) in children with congenital heart disease requiring bypass surgery in the first year of life: Results from a single-center prospective observational study

Abstract

Introduction

Suboptimal neurodevelopmental issues concern 30 to 60% of infants with congenital heart disease, cardiac surgery before 1 year being a major risk factor. We ought to demonstrate the association between pediatric feeding disorders (PFD) and suboptimal neurodevelopment (SND) in this population.

Method

We conducted a prospective study to assess the prevalence of PFD, as defined by Goday et al., diagnosed by a speech therapist, and their correlation with SND at twelve months in children who underwent surgery with cardiopulmonary bypass (CPB) before the age of one. A total of 45 children were included between October 2020 and February 2024 in a systematic monitoring protocol of our institution.

Results

Preoperatively, 38% of infants had a PFD, compared to 29% at twelve months (Figure 1a) Additionally, 77% showed suboptimal neurodevelopment (SND) (defined by ASQ < 2SD and/or AIMS <5 ^th percentile) at 12 months (Figure 1b and c). No significant association was found between PFD and neurodevelopment at twelve months, but preoperative PFD was linked to SND at twelve months (p = 0,03). Infants with preoperative PFD were more cyanotic before surgery (p = 0.017), underwent surgery at an older age (p = 0.013), and had a smaller head circumference at twelve months (p = 0.006) compared to those without feeding disorders. The presence of a nasogastric tube (NGT) was associated with preoperative PFD (p = 0.01), and with 12 months PFD (p = 0.01) but positive predictive value was low (VPP respectively 61% and 50%). NGT pre or postoperatively was not significantly associated with neurodevelopment outcome at twelve months. But 12 months PFD was associated with lower ASQ communication result (p = 0.04).

Conclusion

Feeding difficulties diagnosed by speech therapists (and not only the presence of a feeding tube) appearing before surgery could serve as an early warning sign to predict neurodevelopmental issues in this population and help identify prematurely children that will need dedicated support.