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Prolonged Enteral Tube Feeding in Infants With a Functional Single Ventricle Is Associated With Adverse Outcomes
Emma Payne1, Frances Garden2, Yves d'Udekem3
1The University of Sydney, Sydney, Australia; The University of Melbourne, Melbourne, Australia.
Insights
Long-term tube feeding in single ventricle patients indicates poorer growth and worse outcomes after the Fontan procedure. This highlights the need for closer monitoring and intervention for these vulnerable children.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Single ventricle (SV) physiology presents complex challenges in pediatric cardiology.
- The Fontan procedure is a palliative surgery for SV patients, but long-term outcomes remain a concern.
- Enteral tube feeding (TF) in infancy may indicate underlying health issues affecting growth and development.
Purpose of the Study:
- To characterize baseline features of long-term tube-fed (TF) single ventricle patients.
- To investigate the relationship between long-term enteral tube feeding and patient growth.
- To determine the association between long-term tube feeding and outcomes following the Fontan procedure.
Main Methods:
- A retrospective cohort study was conducted using data from the Australia and New Zealand Fontan Registry (1981-2018).
- Patients were categorized as tube-fed (TF) or non-tube-fed (NTF) based on feeding status at 90 days of age.
- Comparisons included body mass index (BMI) trajectory, BMI at follow-up, and incidence of severe Fontan failure.
Main Results:
- Of 390 patients, 56 (14%) were TF. TF was linked to specific cardiac conditions and prior surgical interventions.
- TF patients exhibited less favorable BMI trajectories and lower weight/length z-scores in early life.
- Long-term, TF patients had reduced odds of being overweight/obese in childhood but increased odds of being underweight in adulthood, and a higher risk of severe Fontan failure.
Conclusions:
- Prolonged infant enteral tube feeding serves as an independent indicator of suboptimal growth.
- Long-term tube feeding is associated with adverse clinical outcomes that persist post-Fontan procedure.
- These findings underscore the significance of early growth assessment and nutritional support in single ventricle patients.
Objectives:
To define the baseline characteristics of long-term tube-fed (TF) single ventricle patients, investigate associations between long-term enteral tube feeding and growth, and determine associations with long-term outcomes after Fontan procedure.
Study Design:
We performed a retrospective cohort study of patients in the Australia and New Zealand Fontan Registry undergoing treatment at the Royal Children's Hospital, the Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. Patients were defined as TF or non-tube-fed (NTF) based on enteral tube feeding at the age of 90 days. Feeding groups were compared regarding body mass index (BMI) trajectory, BMI at last follow-up, and long-term incidence of severe Fontan failure.
Results:
Of 390 patients (56 [14%] TF, 334 [86%] NTF), TF was associated with right ventricular dominance, hypoplastic left heart syndrome, Norwood procedure, increased procedures prior to Fontan, extracardiac conduit Fontan, Fontan fenestration, and atrioventricular valve repair/replacement. TF patients were less likely to be in the higher compared with lowest 0-6 month BMI trajectory (P < .01; P = .03), had lower 6 month weight-for-age z-scores (P < .01) and length-for-age z-scores (P = .01). TF were less likely to be overweight/obese at pediatric follow-up (hazard ratio [HR] = 0.31, 95% CI: 0.12-0.80; P = .02) and more likely to be underweight at adult follow-up (HR = 16.51; 5% CI: 2.70-101.10; P < .01). TF compared with NTF was associated with increased risk of severe Fontan failure (HR = 4.13; 95% CI = 1.65-10.31; P < .01).
Conclusions:
Prolonged infant enteral tube feeding is an independent marker of poor growth and adverse clinical outcomes extending long-term post-Fontan procedure.
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