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Objective: To test the hypothesis that specific echocardiographic measurements of right ventricle (RV) mechanics at 36 weeks post-menstrual age (PMA) are associated with severity of bronchopulmonary dysplasia (BPD). Study design: A subset of 93 preterm infants (born between 27 and 29 weeks gestation) was retrospectively selected from a prospectively enrolled cohort. BPD was defined using the National Institutes of Health workshop definition, with modifications for oxygen reduction testing and altitude. The cohort was divided into no BPD and BPD using previously published methodology for analyses. Echocardiographic measurements of RV function (tricuspid annular plane systolic excursion, fractional area of change, systolic to diastolic ratio, tissue Doppler myocardial performance index, RV strain), RV remodeling/morphology (end-systolic left ventricular (LV) eccentricity index and RV afterload (pulmonary artery acceleration time measures) were evaluated at 36 weeks PMA. Multivariable logistic regression determined associations between RV measurements and BPD severity. Results: Compared with the no BPD cohort, the BPD group had lower birth weight z-scores (P = .04) and trended toward male predominance (p = 0.08). After adjusting for birth weight z-scores, gestational age and sex, there were no differences in echocardiographic measurements between groups except for the EI (scaled odds ratio (0.1-unit increase) of 1.49 (1.13 – 2.12, p = 0.01). Conclusions: Among conventional and emerging echocardiographic measurements of RV mechanics, EI was the only parameter independently associated with BPD severity in this study. The EI may be a useful echocardiographic measurement to characterize RV mechanics in patients with BPD at 36 weeks PMA.

Introduction:Variable compliance to postoperative feeding algorithms after pediatric cardiac surgery may be associated with suboptimal growth, decreased parental satisfaction, and prolonged hospital length of stay (LOS). Our heart center performed an audit of compliance to a previously introduced postoperative feeding algorithm to guide quality improvement efforts. We hypothesized that algorithm noncompliance would be associated with increased LOS.Methods:We retrospectively identified children ≤ 3 months admitted for their first cardiac surgery between January 1, 2015 and December 31, 2016. The algorithm uses objective oral feeding readiness assessments (FRA). At the end of a predefined evaluation period, a “sentinel” FRA score is assigned. The sentinel FRA and FRA trend guide decisions to pursue gastrostomy tube (GT) or oral-only feeds. Among those who reached the sentinel FRA, we defined compliance as ≤ 3 days before pursuing GT or oral-only feeds once indicated by the algorithm.Results:Sixty-nine patients were included. Forty-nine complied with the algorithm (71%), and 45 received GT (65.2%). Noncompliers had significantly longer LOS (34 versus 25 days; P = 0.01). Among GT recipients, noncompliers waited 6 additional days for a GT compared with compliers (P ≤ 0.001). Subjective decisions to extend oral feeding trials or await results of a swallow study were associated with algorithm noncompliance.Conclusions:This audit of compliance to a feeding algorithm after pediatric cardiac surgery highlighted variability of practice, including relying on subjective appraisals of feeding skills over objective FRAs. This variability was associated with increased LOS and can be hypothesis-generating for future quality improvement efforts.