Supplemental Tube Feeding Does Not Mitigate Weight Loss in Infants with Shunt-Dependent Single-Ventricle Physiology
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ORIGINAL ARTICLE
Supplemental Tube Feeding Does Not Mitigate Weight Loss in Infants with Shunt-Dependent Single-Ventricle Physiology Michael V. Di Maria • Andrew C. Glatz • Chitra Ravishankar • Michael D. Quartermain Christina Hayden Rush • Michael Nance • J. William Gaynor • David J. Goldberg
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Received: 20 November 2012 / Accepted: 24 January 2013 / Published online: 20 February 2013 Ó Springer Science+Business Media New York 2013
Abstract Infants with shunt-dependent single-ventricle (SV) physiology are at risk for poor weight gain before superior cavopulmonary connection (SCPC). Lower weight-for-age z-score is a risk factor for prolonged length of stay (LOS) after SCPC. We sought to characterize infant growth and feeding and determine the effect of method of feeding on outcomes. Chart review of infants with shuntdependent SV physiology born between October 2007 and September 2010 was performed. The cohort was divided into three groups based on feeding method at discharge after initial palliation; 53 in the oral feeding (PO) group, 56 in the nasogastric (NG) tube group, and 26 in the gastrostomy tube (GT) group. Birth weight z-score did not differ among groups (p = 0.39), but infants fed by NG or GT were smaller than PO-fed infants at hospital discharge (p = 0.0001), a difference that persisted through SCPC M. V. Di Maria A. C. Glatz C. Ravishankar C. H. Rush M. Nance J. William Gaynor D. J. Goldberg (&) The Cardiac Center, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA e-mail: [email protected] M. V. Di Maria e-mail: [email protected] M. V. Di Maria A. C. Glatz C. Ravishankar D. J. Goldberg Department of Pediatrics, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA M. D. Quartermain Wake Forest University School of Medicine, Winston-Salem, NC, USA M. Nance J. William Gaynor Department of Surgery, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
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(p \ 0.0001). Predictors of need for GT included Norwood procedure (p = 0.008) and longer LOS after initial palliation (p \ 0.001). Interstage mortality and age at SCPC did not differ among groups. Risk factors for longer LOS at SCPC included longer LOS and need for supplemental feeds at discharge from initial palliation as well as lower weight at SCPC. Poor growth is common among infants with shunt-dependent SV physiology. Infants who require GT have lower weight-for-age z-scores at hospital discharge and remain smaller at SCPC than those fed PO. Although GT after initial palliation is associated with longer LOS after SCPC, it is not associated with an increase in interstage morbidity or mortality. Keywords Congenital heart defects Single ventricle Enteral nutrition Norwood surgery Abbreviations SV Single ventricle SCPC Superior cavopulmonary connection PO Oral feeding NG Nasogastric tube GT Gastrostomy tube HLHS Hypoplastic left heart syndrome DHCA Deep hypothermic circulatory arrest
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