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Interstage feeding and weight gain in infants following the Norwood operation: can we change the outcome?

  • Karen Uzark (a1), Yu Wang (a2), Nancy Rudd (a3), E. Marsha Elixson (a4), Jennifer Strawn (a5), Jo Ann Nieves (a6), Cathy Smith (a7), Sandra Staveski (a8), Patricia O'Brien (a9), Elizabeth Tong (a10) and Richard Ittenbach (a11)...

Poor weight gain is common in infants after Stage I Norwood operation and can negatively impact outcomes.


The purpose of this study was to examine the impact of feeding strategy on interstage weight gain.


In a multi-centre study, 158 infants discharged following the Norwood operation were enrolled prospectively. Weight and feeding data were obtained at 2-week intervals. Differences between feeding regimens in average daily weight gain and change in weight-for-age z-score between Stage I discharge and Stage II surgery were examined.


Discharge feeding regimens were oral only in 52%, oral with tube supplementation in 33%, and by nasogastric/gastrostomy tube only in 15%. There were significant differences in the average daily interstage weight gain among the feeding groups – oral only 25.0 grams per day, oral/tube 21.4 grams per day, and tube only 22.3 grams per day – p = 0.019. Tube-only-fed infants were significantly older at Stage II (p = 0.004) and had a significantly greater change in weight-for-age z-score (p = 0.007). The overall rate of weight gain was 16–32 grams per day, similar to infant norms. The rate of weight gain declined over time, with earlier decline observed for oral- and oral/tube-fed infants (less than 15 grams per day at 5.4 months) in comparison with tube-only-fed infants (less than 15 grams per day at 8.6 months).


Following Stage I Norwood, infants discharged on oral feeding had better average daily weight gain than infants with tube-assisted feeding. The overall weight gain was within the normal limits in all feeding groups, but the rate of weight gain decreased over time, with an earlier decline in infants fed orally.

Corresponding author
Correspondence to: Dr K. Uzark, PhD, CPNP, University of Michigan Mott Children's Hospital, L1242 Women's, SPC 5204, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5204, United States of America. Tel: +1 734 615 9748; Fax: +1 734 232 3744; E-mail:
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1. DK Kelleher , P Laussen , A Teixeira-Pinto , C Duggan . Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237244.

2. KN Vogt , C Manhliot , G VanArsdell , Somatic growth in children with single ventricle physiology. JACC 2007; 50: 18761883.

4. D Davis , S Davis , K Cotman , Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328333.

5. JB Anderson , RH Beekman , WL Border , Lower weight-for-age Z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397404.

6. LT Eskedal , PS Hagemo , E Seem , Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495501.

7. D Boctor , F Pillo-Blocka , B McCrindle . Nutrition after cardiac surgery for infants with congenital heart disease. Nutr Clin Pract 1999; 14: 111115.

9. G Wernovsky , N Ghanayem , RG Ohye , Hypoplastic left heart syndrome: consensus and controversies in 2007. Cardiol Young 2007; 17 (Suppl 2): 7586.

10. ML Skinner , LA Halstead , CS Rubinstein , Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 12931301.

11. C Srinivasan , R Sachdeva , W Robert , Standardized management improves outcome after the Norwood procedure. Congenit Heart Dis 2009; 4: 329337.

13. C Srinivasan , RDB Jaquiss , WR Morrow , Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome. Congenit Heart Dis 2010; 5: 546551.

14. NS Ghanayem , GM Hoffman , KA Mussatto , Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 2003; 126: 13671377.

16. JM Simsic , SM Bradley , MR Stroud , AM Atz . Risk factors for interstage death after the Norwood procedure. Pediatr Cardiol 2005; 26: 400403.

17. DA Hehir , TE Dominguez , JA Ballweg , Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2008; 136: 9499.

18. LL Lai , PC Laussen , CL Cua , Outcomes after bidirectional Glenn operation: Blalock–Taussig shunt versus right ventricle-to-pulmonary artery conduit. Ann Thorac Surg 2007; 83: 17681773.

19. M Steltzer , N Rudd , B Pick . Nutrition care for newborns with congenital heart disease. Clin Pernatol 2005; 32: 10171030.

20. JB Anderson , RH Beekman , P Eghtesady , Predictors of poor weight gain in infants with single ventricle. J Pediatr 2010; 157: 407413.

21. DT Hsu , V Zak , L Mahoney , Enalapril in infants with single ventricle. Results of a multicenter randomized trial. Circulation 2010; 122: 330340.

22. RV Williams , V Zak , C Ravishankar , Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial. J Pediatr 2011; 159: 10171022.

23. F Pilo-Blocka , I Adatia , W Sharieff , BW McCrindle , S Zlotkin . Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial. J Pediatr 2004; 145: 761766.

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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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