Oral Aversion and Its Risks in Pediatric Heart Transplant Recipients

Abstract

<h3>Purpose</h3> The relationship between nutritional status and oral aversion (OA) in children listed for heart transplant (HT) is understudied. <h3>Methods</h3> Single center retrospective review of pediatric HT recipients from 1/1/2014-3/1/2021. Those who had re-HT, multi-organ transplant, a genetic syndrome or did not survive the HT hospitalization were excluded. Demographics, anthropometric and nutritional data was collected from HT listing (HTL) through at least 3 months post-HT. Malnutrition was defined by the ASPEN guidelines, as weight for age, height for age, or BMI for age z-scores ≤ -2. OA was defined as needing supplemental feeds to meet estimated caloric needs; excluding those who were NPO for medical reasons like aspiration. <h3>Results</h3> Of 104 patients, 30 (29%) needed supplemental feeds at HTL, 36 (35%) at HT and 35 (34%) 3 months post-HT. The average duration of feeds from HTL to HT was 114 ± 16 days. Younger patients were more likely to need supplemental feeds at HTL (<i>P</i>=0.01) and HT (<i>P</i><0.01). Risk factors for OA at 3 months included younger age (<i>P</i><0.001), 1A Status at HTL (P=0.01) and HT (<i>P</i><0.01), total list days (<i>P</i>=0.03), malnourishment at HTL (<i>P</i>=0.01) and HT (<i>P</i><0.01) and needing supplemental feeds at HT (<i>P</i><0.001). VAD support did not mitigate supplemental feeds 3 months post-HT (<i>P</i>=0.31). <h3>Conclusion</h3> Approximately 1/3 of children require supplemental feeds at HTL which persists through 3 months post-HT. Risk factors for post-HT OA include status 1A, malnourishment and need for supplemental feeds at HTL. Patient education for those at risk should include expectations regarding the need for ongoing supplemental feeds post-HT.