Feeding methods for infants with single ventricle physiology are associated with length of stay during stage 2 surgery hospitalization

• Published in: Congenital heart disease Vol. 14; no. 3; p. 438
• Main Authors: Hoch, Jeannine M, Fatusin, Oluwatosin, Yenokyan, Gayane, Thompson, W Reid, Lefton-Greif, Maureen A
• Format: Journal Article
• Language: English
• Published: United States 01.05.2019
• Subjects: Age Factors; Bottle Feeding; Cardiac Surgical Procedures - adverse effects; Child Development; Enteral Nutrition; Feeding Methods - adverse effects; Feeding Methods - instrumentation; Female; Gastrostomy; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Hospitalization; Humans; Infant; Infant Nutritional Physiological Phenomena; Length of Stay; Male; Nutritional Status; Palliative Care; Registries; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; deglutition; hypoplastic left heart syndrome; stage 2 palliation; single ventricle; feeding
• ISSN: 1747-0803
• DOI: 10.1111/chd.12742

Tube feedings are often needed to achieve the growth and nutrition goals associated with decreased morbidity and mortality in patients with single ventricle anatomy. Variability in feeding method through the interstage period has been previously described, however, comparable information following stage 2 palliation is lacking. To identify types of feeding methods following stage 2 palliation and their influence on length of stay. Secondary analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry was performed on 932 patients. Demographic data, medical characteristics, postoperative complications, type of feeding method, and length of stay for stage 2 palliation were analyzed. Type of feeding method remained relatively unchanged during hospitalization for stage 2 palliation. Gastrostomy tube fed only patients were the oldest at time of surgery (182.7 ± 57.7 days, P < .001) and had the lowest weight-for-age z scores at admission (-1.6 ± 1.4, P < .001). Oral + gastrostomy tube groups had the longest median bypass times (172.5 minutes, P = .001) and longest length of stay (median 12 days, P < .001). Multivariable modeling revealed that feeding by tube only (P < .001), oral + tube feeding (P ≤ .001), reintubation (P < .001), and prolonged intubation (P < .001) were associated with increased length of stay. Neither age (P = .156) nor weight-for-age z score at admission (P = .066) was predictive of length of stay. Feeding methods established at admission for stage 2 palliation are not likely to change by discharge. Length of stay is more likely to be impacted by tube feeding and intubation history than age or weight-for-age z score at admission. Better understanding for selection of feeding methods and their impact on patient outcomes is needed to develop evidence-based guidelines to decrease variability in clinical practice patterns and provide appropriate counseling to caregivers.