The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial

Abstract

Abstract Neonates who require surgery for congenital heart disease (CHD) frequently have difficulty with oral feeds post-operatively and may require a feeding tube at hospital discharge. The purpose of this study was to determine the effect of oral or nasal intubation route on feeding method at hospital discharge. This was a non-blinded randomized control trial of 62 neonates who underwent surgery for CHD between 2018-2021. Infants in the nasal (37 patients) and oral (25 patients) groups were similar in terms of pre-operative risk factors for feeding difficulties including gestational age at birth (39 vs 39 weeks), birthweight (3530 vs 3100 grams), preoperative PO intake (92% vs 81%), and rate of preoperative intubation (28% vs 22%). Surgical risk factors were also similar including STAT category, shunt placement (32% vs 41%), cardiopulmonary bypass time (181 vs 177 minutes), and cross clamp time (111 vs 105 minutes). 96% of nasally intubated patients took full oral feeds by discharge as compared with 78% of orally intubated infants. Nasally intubated infants reached full oral feeds an average of three days earlier than their orally intubated peers. In this cohort of patients, nasally intubated infants reach oral feeds more quickly and are less likely to require supplemental tube feeding in comparison to orally intubated peers. Intubation route is a potential modifiable risk factor for oral aversion and appears safe in neonates. The study was approved by the University of Virginia Institutional Review Board for Health Sciences Research and was retrospectively registered on clinicaltrials.gov (NCT05378685) on May 18, 2022.