Janelle Buysse
Pediatric Cardiology Fellow
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA
Disclosure information not submitted.
Chaorong Wu, Ph.D.
Biostatistician
University of Iowa, United States
Disclosure information not submitted.
Trudy Pierick, MSN, ARNP, FAHA
Pediatric Nurse Practitioner Single Ventricle Program Coordinator
University of Iowa Stead Family Children's Hospital, United States
Disclosure information not submitted.
Benjamin Reinking, M.D.
Clinical Professor, Pediatric Cardiology
University of Iowa Stead Family Children's Hospital, United States
Disclosure information not submitted.
Title: Comparison of Feeding Modalities during the Interstage Period
BACKGROUND: In patients with hypoplastic left heart syndrome, the interstage period, between stage 1 palliation (S1P) and stage 2 palliation (S2P) admission remains a high-risk time despite advances in interstage care. Weight gain is associated with transplant free interstage survival and better outcomes during admission for S2P. Feeding modalities used during the interstage period vary significantly between centers. The aim of this study was to compare interstage morbidity in infants fed orally, via enteral tube or by a combination of enteral tube and oral feedings.
Methods: This was a single center retrospective study of discharged interstage patients from 2013-2019. Those who underwent transplant or died during the interstage period were excluded from weight gain analysis. Weight gain and unplanned readmissions were compared using least square means among the feeding modalities.
Results: 30 patients were identified and categorized into three groups based on primary method of feeding used for the majority of the interstage period. These groups were: enteral tube only, combination of enteral tube and oral, and oral only. Weight for age Z-score at discharge from S1P was compared to weight for age Z-score at S2P in 26 patients who survived the interstage period. Infants fed orally during the interstage period experienced less decrease in weight for age z-score in comparison with combination and enteral tube groups (mean decrease of 0.32, 1.78 and 1.88, respectively, p < 0.05). There was no significant difference between combination and enteral tube groups. There were 48 unplanned readmissions for the 30-patient cohort. Enteral tube fed infants had significantly more unplanned readmissions than either oral or combination groups (median of 3.5, 1 and 1 respectively, p < 0.05). There was no significant difference in number of readmissions between oral and combination groups. 4 patients underwent transplant or died during the interstage period (3 in combination group and one in enteral tube group).
Conclusions: In our center, infants fed via oral route had better outcomes across the interstage period. Those fed exclusively orally had better weight gain, and those fed exclusively with enteral tube had more unplanned readmissions.