Supplemental tube feeding does not mitigate weight loss in infants with shunt-dependent single-ventricle physiology

Area of Science:

• Pediatric Cardiology
• Neonatology
• Surgical Outcomes

Background:

• Infants with shunt-dependent single-ventricle (SV) physiology face challenges with weight gain prior to the superior cavopulmonary connection (SCPC).
• Lower weight-for-age z-scores are identified as a risk factor for extended length of stay (LOS) post-SCPC.
• Understanding infant growth and feeding is crucial for optimizing outcomes in this population.

Purpose of the Study:

• To characterize growth patterns in infants with shunt-dependent SV physiology.
• To determine the impact of different feeding methods on infant outcomes.
• To identify factors influencing the need for gastrostomy tube (GT) feeding.

Main Methods:

• Retrospective chart review of infants with shunt-dependent SV physiology (October 2007 - September 2010).
• Cohort divided into three feeding groups: oral (PO), nasogastric (NG) tube, and gastrostomy tube (GT).
• Analysis of birth weight z-score, weight at discharge, weight at SCPC, LOS, and interstage mortality.

Main Results:

• Infants requiring NG or GT feeding were smaller at hospital discharge and remained smaller at SCPC compared to PO-fed infants.
• The Norwood procedure and longer initial palliation LOS predicted the need for GT feeding.
• While GT feeding was associated with longer LOS after SCPC, it did not increase interstage mortality or affect age at SCPC.

Conclusions:

• Poor growth is prevalent in infants with shunt-dependent SV physiology.
• Gastrostomy tube feeding in this cohort is associated with poorer weight status and longer hospitalizations post-SCPC.
• Gastrostomy tube use does not appear to elevate interstage morbidity or mortality risks.