Introduction:  Infants requiring a heart transplant (HTx) are known to be at risk for poor oral intake. They may not achieve medical stability conducive to full or partial oral feeding prior to HTx making the transition to exclusive oral feeding post-HTx a lengthy process, often requiring tube assisted feeding support.  The study objective was to describe our experience with tube assisted feeding and the transition to oral feeding for children from the time of listing through the post-HTx period.
Methods: This retrospective study examined children who received a HTx <2 years of age. Variables collected included patient demographics, feeding method (at time of listing, transplant, 3, 6 and 12 months post-HTx), and associated conditions. Children were stratified into those requiring tube assisted feeding <3 months post-HTx and those that required it for >3 months. 
Results: There were 30 children (40% male) included in this study, 13 (43%) with an underlying diagnosis of cardiomyopathy and 15 (50%) with congenital heart disease; 9 (30%) experienced a neurologic event and 3 (10%) required ECMO post-HTx. Seven (23%) had clinical aspiration on occupational therapist (OT) assessment, 3 (10%) had vocal cord palsy and 8 (27%) had documented feeding aversion.  Feeding route at key time points is displayed in Figure 1. 

Twenty-seven (90%) required tube assisted feeding or intravenous nutrition at the time of HTx.  Sixteen (53%) received a gastrostomy tube of which 9 (30%) were placed post-HTx. Fourteen (47%) required tube assisted feeding for >3 months of whom 8 (80%) eventually transitioned to oral feeds at a median time of 220 days (IQR: 121-425 days); 6 (20%) continue to require tube assisted feeding to date. Factors associated with tube assisted feeding >3 months post-HTx included older age, delayed chest closure post-HTx and evidence of a neurologic event (Table 1).

Conclusion: Tube assisted feeding is common pre- and post-HTx.  Children that experienced a neurologic event or complicated initial post-HTx course tended to require tube assisted feeding for longer.  Understanding the duration of tube assisted feeding is important for resource allocation and managing parental expectations. Achieving oral feeding remains a challenge for children post-HTx, necessitating access to experienced practitioners and resources.