Feeding status after pediatric laryngotracheal reconstruction

Abstract

OBJECTIVE: To determine the influence of pediatric laryngotracheal reconstruction (LTR) on postoperative feeding status and longitudinal weight gain after surgery. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care pediatric hospital. SUBJECTS AND METHODS: We identified 30 consecutive pediatric patients undergoing LTR from November 2005 to October 2008. Demographics, stenosis grade, surgical procedure, decannulation status, preoperative feeding status and weight, discharge feeding status, and weights at follow-up were collected. Weights were plotted on standardized growth charts at surgery, during the early postoperative period (1–3 months), and during the late postoperative period (10–14 months). Growth percentiles were compared by the use of Wilcoxon signed rank test. RESULTS: Twenty-eight patients (97%) maintained or advanced their feeding status after LTR. Twenty-one patients (72%) were oral feeders at surgery. All of these patients continued the same oral diet postoperatively. Five patients (17%) were dependent on gastrostomy before and after surgery. Three patients (10%) were fed via naso- or orogastric tubes at surgery. Two of these patients were discharged on an oral diet, and one required a gastrostomy tube. The median growth percentiles at the time of surgery, early postoperative, and late postoperative periods were nine, 18, and 32, respectively. Differences between percentiles at the time of surgery compared with early ( P = 0.081) and late follow-up ( P = 0.074) were not significant. In patients who were not dependent on gastrostomy, there was a significant increase in growth percentile at early follow-up ( P = 0.026). CONCLUSION: The performance of LTR does not influence feeding status. An early increase in median growth percentile is observed in oral feeders, but overall long-term median growth percentiles remain stable after LTR. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.