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Evaluation of growth and feeding tolerance in infants with single-ventricle physiology receiving retrospective standard of care feeding regimens compared with protocolised formula or exclusive human milk feeding regimens

Published online by Cambridge University Press:  30 September 2024

Megan Horsley Open the ORCID record for Megan Horsley [Opens in a new window] ,
Amiee Trauth ,
David S. Cooper ,
Cynthia Blanco ,
Zhiqian Gao  and
Lindsey Justice Open the ORCID record for Lindsey Justice [Opens in a new window]
Megan Horsley
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Amiee Trauth
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
David S. Cooper
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Cynthia Blanco
Affiliation:
Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center San Antonio; Women’s and Children’s Hospital, San Antonio, TX, USA
Zhiqian Gao
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Lindsey Justice*
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Corresponding author: Lindsey Justice; Email: Lindsey.justice@cchmc.org
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Abstract

Objective:

Determine whether weight gain velocity (g/day) 30 days after initiating feeds following cardiac surgery and other clinical outcomes improve in infants with single-ventricle physiology fed an exclusive human milk (EHM) diet with early fortification compared to non-protocolised “standard of care.”

Methods:

This retrospective cohort study compares term infants with single-ventricle physiology who underwent neonatal surgical palliation. The retrospective control group (RCG) was fed according to non-protocolised standard of care at a single centre and was compared with infants in a previous protocolised multi-site randomised controlled trial assigned to either an EHM group or a control group (TCG). The primary outcome measure is weight gain velocity. Secondary outcomes include change in weight z-score, and incidence of feeding intolerance and necrotising enterocolitis.

Results:

We evaluated 45 surgically palliated neonates with single-ventricle physiology compared to the prior trial patients (EHM = 55, TCG = 52). Baseline demographics were similar between groups, except the RCG had fewer patients with hypoplastic left heart syndrome (51% vs. 77% vs. 84%, p = 0.0009). The RCG grew similarly to the TCG (7.5 g/day vs. 8.2 g/day), and both groups had significantly lower growth than the EHM group (12 g/day). Necrotising enterocolitis/suspected necrotising enterocolitis were similar in the RCG versus TCG but significantly higher in the RCG compared to the EHM group (20.5% vs. 3.6%, p = 0.033). Incidences of other morbidities were similar.

Conclusions:

Neonates with single-ventricle physiology have improved short-term growth and decreased risk of necrotising enterocolitis or suspected necrotising enterocolitis when receiving an EHM diet after surgical palliation compared to non-protocolised feeding with bovine formula.

Keywords

Human milksingle-ventricle physiologygrowthfeeding tolerance

Information

Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 10 , October 2024 , pp. 2170 - 2177
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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