Variation in feeding practices following the Norwood procedure

Area of Science:

• Pediatric Cardiology
• Neonatal Nutrition
• Surgical Outcomes

Background:

• The Norwood procedure is a critical first step for infants with single ventricle congenital heart disease.
• Optimal nutritional support and feeding strategies post-procedure are essential for infant growth and development.
• Variability in clinical practice can impact patient outcomes.

Purpose of the Study:

• To evaluate differences in infant feeding practices at hospital discharge following the Norwood procedure.
• To identify factors associated with the use of tube feeding.
• To examine the relationship between feeding method, hospital site, and infant growth prior to the second stage of palliation.

Main Methods:

• Analysis of feeding data from 432 infants discharged after the Norwood procedure, enrolled in the Pediatric Heart Network Single Ventricle Reconstruction Trial (May 2005-July 2008).
• Comparison of feeding modes: oral only, oral/tube, nasogastric tube (N-tube) only, and gastrostomy tube (G-tube) only.
• Multivariable modeling adjusted for hospital site to assess associations between feeding mode, hospitalization duration, medications, and weight-for-age z-scores.

Main Results:

• Significant variation in feeding practices (oral only, G-tube only) was observed across participating centers (P < .01).
• G-tube feeding at discharge correlated with longer hospitalizations, while N-tube feeding was associated with a higher number of discharge medications (R(2) = 0.65, P < .01).
• Infants fed orally only had significantly higher pre-stage II weight-for-age z-scores compared to those fed exclusively by N-tube or G-tube (P = .04 and .02, respectively).

Conclusions:

• Feeding strategies post-Norwood procedure differ substantially among hospitals.
• Tube feeding is associated with increased morbidity, indicated by longer hospital stays and more medications.
• Promoting oral feeding in this high-risk infant population may improve nutritional status and warrants further investigation into preventative strategies.