Table 1.
Summary of findings.
| Author and Title | Location | Research design | Sample size | Participant description | Recruitment age | Comparison group | Follow-up duration | Prevalence of FSD | Adapted NOS score |
|---|---|---|---|---|---|---|---|---|---|
| Davis et al. (9) | US | Retrospective chart review | 53 | 27 infants with HLHS; 26 infants with d-TGA No gestational age not reported |
Birth | Compared HLHS with d-TGA | 12 months | 49% required some form of tube feeding at discharge: 25% NGT; 21% NGT + oral; 3% g-tube; 8% aspirated |
3/7 |
| De Souza et al. (10) | Brazil | Cross-sectional study | 31 | 31 infants with diagnosis of CHD including: septal defects (ASD; VSD; AVSD); PDA; pulmonary stenosis; aortic supravalvular stenosis; coarctation of the aorta; TGA; tricuspid atresia; intracardiac tumor; patent foramen ovale; HLHS; aortic arch hypoplasia. No gestational age reported |
13–42 days (mean 21 days) | None | None | 74% dysphagia 32% (10) = mild 23% (7) = moderate 19% (6) = severe |
6/7 |
| Einarson and Arthur (11) | Canada | Retrospective chart review | 101 | 101 neonates with CHD requiring surgical intervention in the first 28 days of life. CHD diagnoses included: univentricular heart; left-sided abnormalities; total anomalous venous drainage; TGA; TOF; truncus arteriosis. No gestational age reported |
Neonates (0–28 days) | None | Until hospital discharge (up to 4 months) | 28.7% non-oral feeding at discharge | 5/7 |
| Hill et al. (12) | US | Prospective cross-sectional | 56 | 56 participants; 2–6 years with single ventricle defects; completed stage 2 palliation before age 2 years. No gestational age or history of prematurity reported. |
2–6 years | Compared children with single ventricle defects to “normal population cohort” | None | 28 (50%) feeding dysfunction. Caregivers of children with CHD reported significantly more of the following difficulties: “food manipulation” (p <0.001); “mealtime aggression” (p = 0.002); “choking, gagging and vomiting” (p <0.001); “child's resistance to eating” (p <0.001); and “parental aversion to mealtimes” (p <0.001) |
3/7 |
| Kogon et al. (13) | US | Retrospective review | 83 | 83 participants who had surgery for CHD in first 15 days of life (neonates). Mean gestational age of 38.3 weeks ± 1.82. |
Neonates (<15 days) | None | Until hospital discharge | 11% required prolonged time to reach full oral feeds (>19 days) 45% discharged home with tube feeding |
3/7 |
| Kohr et al. (14) | US | Prospective, cross-sectional | 50 | 50 participants 0–17 years evaluated post TEE. CHD included: anomalous left coronary artery; anomalous pulmonary venous drainage; aortic stenosis; ASD; VSD; cardiomyopathy; coarctation of aorta with VSD; complex single ventricle-HLHS or tricuspid atresia; congenital mitral stenosis; pulmonary atresia; Taussig-Bing anomaly; TOF. Excluded preterm infants. |
0–17 years | None | 18% dysphagia | 6/7 | |
| Lundine et al. (15) | US | Retrospective cohort chart review | 50 | 50 infants with single ventricle physiology who underwent hybrid procedure (and had VFSS results post-surgery). CHD of HLHS or functional single ventricle. Included premature infants; reported no statistically significant relationship between prematurity and aspiration. |
Neonates | None | Unknown | 44% normal; 28% penetration on Penetration-Aspiration Scale and 28% aspiration (13/14 silent aspiration). | 6/7 |
| Maurer et al. (16) | Switzerland | Retrospective study | 82 | 82 participants at 2 years who had surgery for CHD in first 32 days of life. CHD diagnoses included: TGA; coarctation of the aorta; VSD; double outlet right ventricle with unobstructed outflow tract; TAPV; interrupted aortic arch; tricuspid atresia; pulmonary atresia and ventricular septal defect; TOF; common arterial trunk; HLHS; double inlet left ventricle with hypoplastic aortic arch; complete atrioventricular block; myocardial tumor; PDA. Included participants with a history of prematurity; at 2 years reported no association between history of prematurity and feeding difficulties. |
24 months | None | None (assessed at 2 years with retrospective information) |
22% feeding and swallowing difficulties at 2 years | 4/7 |
| McGrattan et al. (17) | US | Prospective cross-sectional study | 36 | 36 infants (0–36 days) with functional single ventricles following stage 1 palliation; 24 Norwood procedure and 12 Hybrid. CHD diagnoses included: HLHS; right ventricle dominant atrioventricular septal defect; mitral and aortic stenosis; interrupted aortic arch with ventricular septal defect; double outlet right ventricle with straddling mitral valve; double inlet left ventricle with interrupted aortic arch. No gestational age reported. |
Neonates (0–36 days) | Compared those who underwent Norwood procedure and Hybrid | None | 83% (30) penetration on liquids 50% (18) aspiration on liquids |
5/7 |
| McKean et al. (18) | Australia | Retrospective cohort study | 79 | 79 neonates who underwent cardiac surgery during neonatal period (with data for 3 years). CHD diagnoses included: coarctation of aorta; TGA; functional single ventricle; pulmonary atresia; HLHS; TAPV; TOF; truncus arteriosus; interrupted aortic arch. 7 of 79 participants were preterm; reported no statistically significant difference between preterm and term participants with regard to the need for a feeding tube at discharge. |
Neonates (<28 days) | None | 3 years | 30% discharged with feeding tube | 4/7 |
| Pham et al. (19) | US | Retrospective chart review | 104 | 104 neonates requiring Norwood procedure or aortic arch reconstruction. 7 participants were preterm; did not report on preterm participants separately. |
Neonates | Compared Aortic arch reconstruction and Norwood procedure | Mean of 11.5 months (up to 72 months) | 63.5% dysphagia | 5/7 |
| Pourmoghadam et al. (20) | US | Retrospective chart review | 89 | 89 infants undergoing Norwood procedure or aortic arch repair follow-up for ± 3 years. CHD diagnoses included: HLHS; single ventricle with aortic arch hypoplasia; hypoplastic aortic arch with/without VSD; interrupted aortic arch with VSD; hypoplastic aortic arch with TGA No gestational age reported. |
Neonates | Norwood procedure compared to aortic arch repair | Up to 3 years | 48% (43/89) vocal cord dysfunction. 71 participants had VFSS and 42% aspirated. 53 participants had gastrostomy tube placed. |
4/7 |
| Raulston et al. (21) | US | Retrospective chart review | 96 | 96 participants who had surgery for CHD in the first 100 days AND had FEES/MBS post-operatively before initiating oral feeds. 28 of 96 participants were preterm; reported no significant association between prematurity and aspiration. |
<120 days | None | ± 60 days (for some but not part of protocol) | 51% aspirated on FEES or MBS | 3/7 |
| Skinner et al. (22) | US | Prospective cross-sectional study | 51 | 51 infants with CHD, including HLHS, aortic arch hypoplasia, aortic coarctation with VSD, VSD, and coarctation with TGA. 33 underwent Norwood procedure; 18 underwent aortic arch reconstruction as part of biventricular repair. No gestational age reported. |
Neonates | Compared Norwood to biventricular aortic arch repair | 1 year (for some) | 51% overall swallowing dysfunction 28% aspirated. Swallowing dysfunction presented in 48% following Norwood (aspiration 24%) and swallowing dysfunction in 59% following Biventricular (35% aspiration). |
5/7 |
| Yi et al. (23) | Korea | Retrospective chart review | 146 | 146 infants (<12 months) who had cardiac surgery. CHD diagnoses included: large ventricular septal defect or double-outlet right ventricle with unobstructed outflow tract; coarctation of the aorta; TOF; HLHS; TGA; interrupted aortic arch. Mean gestational age was 38 weeks; no specific mention of prematurity. |
<12 months (mean = 3.4 months) | None | Unclear. Follow- up VFSS done up to 6 months after surgery | 24% (35/146) dysphagia | 6/7 |
HLHS, hypoplastic left heart syndrome; (d-)TGA, (dextro)-Transposition of the Great Arteries; NGT, nasogastric tube; VFSS, videofluoroscopic swallow study; TOF, Tetralogy of Fallot; CHD, congenital heart disease; FEES, fibreoptic endoscopic evaluation of swallowing; MBS, modified barium swallow; ASD, atrial septal defect; VSD, ventricular septal defect; AVSD, atrioventricular septal defect; PDA, patent ductus arteriosus; TAPVD, Total anomalous pulmonary venous drainage; VCD, vocal cord dysfunction; TEE, transesophageal echocardiography.
Aspiration was documented on videofluoroscopic swallow studies or fiberoptic endoscopic evaluation of swallowing; vocal cord dysfunction was assessed by laryngoscopy.