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Association of feeding modality with interstage mortality after single-ventricle palliation

Camden L Hebson1, Matthew E Oster, Paul M Kirshbom

  • 1Sibley Heart Center, Children's Healthcare of Atlanta, Ga., USA. chebson@emory.edu

The Journal of Thoracic and Cardiovascular Surgery
|January 17, 2012
PubMed

Insights

Gastrostomy tube feeding after single-ventricle palliation increases interstage mortality risk in neonates. Nasogastric feeding does not elevate this risk, suggesting gastrostomy tube use may indicate underlying comorbidities.

Area of Science:

  • Pediatric Cardiology
  • Neonatal Surgery
  • Critical Care Medicine

Background:

  • Interstage mortality after single-ventricle palliation ranges from 10% to 25% in hospital survivors.
  • Feeding modality at discharge is a critical factor influencing outcomes in these vulnerable infants.

Purpose of the Study:

  • To investigate the association between feeding method at hospital discharge and interstage mortality in neonates following single-ventricle palliation.

Main Methods:

  • Retrospective review of 334 neonates who underwent single-ventricle palliation and survived to discharge (2003-2010).
  • Analysis of preoperative, operative, and postoperative variables, focusing on feeding method at discharge.
  • Multivariate Poisson regression used to calculate the relative risk of interstage mortality.

Main Results:

  • 17% of patients (56/334) received a gastrostomy tube (± Nissen procedure), showing a significantly higher interstage mortality risk (RR, 2.38; P=.04).
  • No significant difference in interstage mortality was observed between patients fed via nasogastric tubes (68%) and those fed orally (32%).

Conclusions:

  • Requirement for a gastrostomy tube (± Nissen) post-palliation is linked to increased interstage mortality, potentially indicating unmeasured comorbidities.
  • Discharge with nasogastric tube feeding is not associated with an increased risk of interstage mortality.
Abstract

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