Retrospective Study of Gabapentin for Poor Oral Feeding in Infants With Congenital Heart Disease

Abstract

Infants who experience extended intensive care stays may lose opportunities for learning to eat and may associate eating with pain or discomfort.1 Feeding difficulties affect 40% to 70% of infants with prematurity or complex medical issues.2 Following severe neonatal pain experiences some infants may present with food refusal or early satiety because they experience oral discomfort, odynophagia, dysphagia, or dyspepsia as a consequence of hyperalgesia, sensitization of peripheral nociceptors, and central nervous system activation of nonspecific arousal systems.3,4 Children born with life-threatening cardiac abnormalities who required corrective or palliative heart surgery are at high risk for oral feeding difficulties.5,6 When oral feeding does not advance in a timely fashion after cardiovascular surgery, infants may require gastrostomy feeding tubes with or without fundoplication.7 Drugs for chronic pain have demonstrated great promise in improving oral feeding outcomes in medically complicated children.8,9 The nerve-stabilizing medication gabapentin has been used for chronic neuropathic pain10 and reduced irritability in neurologically impaired children.11 Furthermore, gabapentin appeared to be an effective adjunct to move medically fragile toddlers from tube to oral feedings.8 In the current study, we hypothesized that feeding difficulties may be related to sensory hypersensitivities of the face and mouth, oropharynx, esophagus, and stomach. We aimed to assess the effect of gabapentin on voluntary oral intake in infants following surgery for congenital heart disease. We selected gabapentin because it is not associated with serious cardiovascular side effects.