Impact of Palliation Strategy on Interstage Feeding and Somatic Growth for Infants With Ductal-Dependent Pulmonary Blood Flow: Results from the Congenital Catheterization Research Collaborative

• Published in: Journal of the American Heart Association Vol. 9; no. 1; p. e013807
• Main Authors: Nicholson, George T, Glatz, Andrew C, Qureshi, Athar M, Petit, Christopher J, Meadows, Jeffery J, McCracken, Courtney, Kelleman, Michael, Bauser-Heaton, Holly, Gartenberg, Ari J, Ligon, R Allen, Aggarwal, Varun, Kwakye, Derek B, Goldstein, Bryan H
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 07.01.2020; Wiley
• Subjects: Age Factors; Blalock-Taussig Procedure - adverse effects; Body Height; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Child Development; Child, Preschool; congenital heart disease; Ductus Arteriosus - diagnostic imaging; Ductus Arteriosus - physiopathology; Feeding Methods - adverse effects; Female; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Male; Original Research; outcomes research; Palliative Care; Pulmonary Circulation; Retrospective Studies; Stents; surgery; Time Factors; Treatment Outcome; United States; Weight Gain; United States; congenital heart disease; outcomes research; surgery
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.013807

Background In infants with ductal-dependent pulmonary blood flow, the impact of palliation strategy on interstage growth and feeding regimen is unknown. Methods and Results This was a retrospective multicenter study of infants with ductal-dependent pulmonary blood flow palliated with patent ductus arteriosus (PDA) stent or Blalock-Taussig shunt (BTS) from 2008 to 2015. Subjects with a defined interstage, the time between initial palliation and subsequent palliation or repair, were included. Primary outcome was change in weight-for-age -score. Secondary outcomes included % of patients on: all oral feeds, feeding-related medications, higher calorie feeds, and feeding-related readmission. Propensity score was used to account for baseline differences. Subgroup analysis was performed in 1- (1V) and 2-ventricle (2V) groups. The cohort included 66 PDA stent (43.9% 1V) and 195 BTS (54.4% 1V) subjects. Prematurity was more common in the PDA stent group ( =0.051). After adjustment, change in weight-for-age -score did not differ between groups over the entire interstage. However, change in weight-for-age -score favored PDA stent during the inpatient interstage ( =0.005) and BTS during the outpatient interstage ( =0.032). At initial hospital discharge, PDA stent treatment was associated with all oral feeds ( <0.001) and absence of feeding-related medications ( =0.002). Subgroup analysis revealed that 2V but not 1V patients demonstrated significant increase in weight-for-age -score. In the 2V cohort, feeding-related readmissions were more common in the BTS group ( =0.008). Conclusions In infants with ductal-dependent pulmonary blood flow who underwent palliation with PDA stent or BTS, there was no difference in interstage growth. PDA stent was associated with a simpler feeding regimen and fewer feeding-related readmissions.