Improving Outcomes for Infants with Single Ventricle Physiology through Standardized Feeding during the Interstage

Area of Science:

• Pediatric Cardiology
• Neonatal Surgery
• Clinical Nutrition

Background:

• Congenital heart disease (CHD) is the most common birth defect.
• Single ventricle physiology presents the highest mortality among CHD cases.
• The interstage period between surgical pallitations has historically high mortality (22%).

Purpose of the Study:

• To evaluate the impact of a standardized postoperative feeding protocol on growth and hospital resource utilization in infants with single ventricle physiology.
• To compare outcomes between infants receiving the standardized feeding approach and those in a control group.
• To assess changes in weight-to-age z-score (WAZ) and length of stay (LOS) post-surgical palliation.

Main Methods:

• Implementation of an evidence-based feeding protocol, incorporating parent engagement and interprofessional team rounds.
• Comparison of five infants with single ventricle physiology pre-protocol (control) against five infants post-protocol (intervention).
• Statistical analysis using Mann-Whitney U tests to compare WAZ changes and LOS between groups.

Main Results:

• The standardized feeding approach led to a significant increase in interstage WAZ change, from 0.05 to 0.91 (nearly one standard deviation).
• Median LOS decreased by 32% after the first surgery and 43% after the second surgery.
• Projected cost savings of $500,000-$800,000 annually per 10 infants due to reduced hospitalizations.

Conclusions:

• A standardized postoperative feeding protocol effectively improves growth in single ventricle infants.
• The protocol significantly reduces length of stay following staged surgical palliation.
• This approach offers substantial hospital cost savings while enhancing patient outcomes.