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Background/Purpose: Many infants with congenital heart disease (CHD) lack effective suck, swallow, and breathing coordination, leading to fluid management problems. While all neonates with CHD are at risk for poor feeding outcomes, infants with single ventricle anomalies may experience a greater incidence of difficulties. The purpose of this study is to describe fluid management in neonates following surgical intervention for single ventricle and biventricular cardiac disease.

Methods: This descriptive observational design used the dynamic Early Feeding Skills Assessment to code infant feeding behaviors from videotaped feedings. Fluid management was coded as the presence/absence of fluid rattles, spills, multiple swallows, gags, coughs, and/or chokes. Number of episodes and duration of fluid management issues were recorded. Data were analyzed using descriptive statistics.

Results: The sample consisted of 8 feedings from 4 infants with single ventricle disease and 5 feedings from 3 infants with biventricular disease. There were 27 episodes within 8 feedings among the single ventricle group (M = 3.4). There were 25 episodes within 5 feedings among the biventricular group (M = 5). All infants had fluid management concerns during at least 1 feed. The average duration of difficulty managing fluid was 6.2% of the total feeding duration among the single ventricle group (range 0% -34.2%), and 6.0% of the total feeding duration among the biventricular group (range 0%-11.6%).

Conclusion: Finding similar occurrences of fluid management difficulty between these two groups of infants with CHD was unexpected. Reports in the literature indicate that infants with single ventricles often experience more feeding issues. However, infants with biventricular disease generally undergo complex surgical interventions using cardiopulmonary bypass (CPB) within the first month of life, whereas the surgery within the first month of life for single ventricle disease at the study hospital (the hybrid approach) is less complex and does not require CPB. This difference in early surgeries may explain our findings. Further research is needed with a larger sample in order to identify potential interventions to support feeding in these vulnerable infants.