WIP 49 - Vocal Cord Paresis Post Congenital Heart Surgery and Enteral Feeding Safety

Publication Number: WIP 49.7680

Amber N. Molin, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Erica Del Grippo, NemoursAlfred I. duPont Hospital for Children, West Chester, PA, United States; Colin Meyer-MacAulay, Nemours Children's Hospital, Yardley, PA, United States; Nicole L. Aaronson, Nemours Children's Hospital of Delaware/Thomas Jefferson Sidney Kimmel School of Medicine, Wilmington, DE, United States; Karli negrin, Nemours Children's Hospital, Mount Laurel, NJ, United States; Deepika Thacker, Nemours Children's Hospital, Wilmington, DE, United States

Background: Vocal cord paresis (VCP) is a common adverse outcome of congenital heart surgery which is the result of injury to the recurrent laryngeal nerve. The risk of injury to this nerve is increased with surgical procedures involving the aortic arch. VCP can manifest in many ways including difficulty with oral feeding, aspiration/silent aspiration, respiratory difficulty, stridor, weak or horse cry. Post-pyloric feeding methods have benefits including reduction in the risk of emesis and aspiration. Post pyloric feeding requires continuous nutrition and is usually not suitable for discharge, conversion to a gastric method of feeding is usually necessary and can increase length of hospital stay.

Objective: There is currently no known literature examining patients with diagnosed VCP which compares the safety of enteral feeds methods pre-pyloric versus post-pyloric. We aim to compare feeding methods of those patients with and without VCP who are status post congenital heart surgery involving aortic arch repair to determine if there is any increased risk of adverse outcomes with a pre-pyloric feeding method compared to those who are fed via post-pyloric methods.

Design/Methods: Retrospective chart review of pediatric patients who had otolaryngology consultation for vocal cord evaluation after high-risk cardiothoracic surgery at our institution from 2021 and 2023. Institutional Review Board approval. 61 met inclusion criteria. Data collected: demographics, cardiac diagnosis, surgical details, respiratory support, feeding methods, length hospital day, barium swallow results. Adverse outcomes defined: aspiration events, aspiration pneumonia, reflux, readmission. Out of the 61 patients; 29 did not have VCP, 32 did have VCP. Out of those who were diagnosed with VCP; 22 were initial fed pre-pylorically, 10 fed post-pylorically. We plan to compare those with and without VCP against variable outcomes collected as well as compare those with VCP and pre-pyloric feeding methods against those with post-pyloric feeding methods to determine if one feeding method has a higher rate of adverse outcome.