(58) Preterm Neonates with Congenital Heart Disease: How to Feed and When to Transport

Background: Preterm neonates are at increased risk of necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH). Congenital heart disease (CHD) increases the risk of both NEC and IVH in neonates regardless of prematurity. There is a paucity of data to support optimal feeding regimens that minimize the risk of NEC in preterm neonates with CHD. Additionally, transport increases the risk of IVH independent of prematurity and CHD. Little is known about the optimal time for transport to surgical center in preterm neonates with CHD to minimize IVH risk.

Objectives: We evaluated preterm neonates with known CHD to better understand optimal feeding patterns and timing of transport to a pediatric cardiothoracic surgical center and the risk of developing either NEC or IVH.

Design/Methods: This is an IRB-approved, retrospective review (August 2017-January 2025) performed at a single center, level III neonatal intensive care unit. We evaluated preterm neonates with known CHD for feeding parameters, transport timing, and development of NEC or IVH during their preoperative course.

Results: 27 preterm neonates (55% male, 45% female, 78% white, 11% black or African American, 11% Asian) with CHD were identified. Gestational age ranged from 29 1/7 to 36 2/7 weeks (mean 34 1/7). Birth weight ranged 1.14-4.63kg (mean 2.15 kg). Diagnoses in decreasing frequency included: coarctation of the aorta/hypoplastic arch, ToF/DORV, VSD, TAPVR, AV canal, TGA, HLHS, and truncus arteriosus. Only 2 babies developed medical NEC (29-week GA w/ ToF and 36-week GA w/ HLHS). No statistical significance was found for risk of NEC and volume of feeds, fortification of feeds, or cardiac diagnosis. Four babies developed IVH (grades 1-2), though none were related to transport.

Conclusions: Minimal conclusions can be extrapolated from this retrospective review given the low n. While single-center guidelines exist for feeding recommendations in the preterm neonate with CHD, there are no national recommendations on how safe max enteral volumes in ml/kg/d, max fortification, or timing of feeding advancement. Transport timing is often dependent upon clinical status and timing of surgical intervention, though the optimal timing of transport of a preterm neonate with CHD to lower IVH risk has not been identified in the literature. Further multi-center studies evaluating the preterm CHD population will need to occur so that we can better optimize preoperative feeding and transport timing in this patient population.