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FEEDING PRACTICE VARIATION AND PREDICTORS OF INFANT WEIGHT FOLLOWING THE NORWOOD PROCEDURE: A REPORT FROM THE PEDIATRIC HEART NETWORK SINGLE VENTRICLE RECONSTRUCTION TRIAL
E746 JACC March 27, 2012 Volume 59, Issue 13
Congenital Cardiology Solutions FEEDING PRACTICE VARIATION AND PREDICTORS OF INFANT WEIGHT FOLLOWING THE NORWOOD PROCEDURE: A REPORT FROM THE PEDIATRIC HEART NETWORK SINGLE VENTRICLE RECONSTRUCTION TRIAL ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: The Single Ventricle Abstract Category: 27. Congenital Cardiology Solutions: Pediatric Presentation Number: 1133-37 Authors: Linda M. Lambert, Nancy Pike, Barbara Medoff-Cooper, victor zak, Victoria Pemberton, Lisa Young-Borkowski, Martha Clabby, Kathryn Nelson, Richard Ohye, Bethany Trainor, Karen Uzark, Nancy Rudd, Louise Bannister, Rosalind Korsin, David Cooper, christian Pizarro, Sinai Zyblewski, Bronwyn Bartle, Richard Williams, Pediatric Heart Network Investigators, Primary Children’s Medical Center, Salt Lake City, UT, USA Background: Poor growth in infants with single right ventricle anomalies (SRV) following the Norwood procedure is associated with significant morbidity. No single feeding strategy has emerged as “best practice” to improve weight gain. We sought to assess center differences in feeding practice at the time of Norwood hospital discharge, predictors of tube feeding, and associations between site, feeding mode, and growth prior to stage II palliation. Methods: From May 2005 to July 2008, 555 subjects were enrolled from 15 centers in the Pediatric Heart Network Single Ventricle Reconstruction Trial; 432 survivors with feeding data at discharge following the Norwood were included in this analysis. Statistical analyses included ANOVA for weight-for-age z-score (WAZ) vs. feeding mode at Norwood discharge and clinical site. Univariate and multivariable logistic regression were used to examine patient and clinical factors associated with tube feeding. Results: Feeding mode was compared among 4 groups: oral only (n=140), oral/tube (n=195), nasogastric tube (NG) only (n=40), and gastrostomy tube (GT) only (n=57). There was significant variation in feeding mode among sites (oral only 0-81% and GT only 0-56%, p<0.01). After adjusting for clinical site, final multivariable regression model showed that GT feeding only is associated with longer hospitalization, while NG feeding only is associated with greater number of discharge medications (R2=0.65, p<0.01). After adjusting for site, mean pre-stage II WAZ was significantly higher in the oral only group (-1.4) vs. the NG only (-2.2) and GT only (-2.1) groups (p=0.04 and 0.02, respectively). There were significant differences in the change in WAZ from Norwood discharge to pre-stage II among sites (p<0.01). Conclusions: Feeding mode varied among centers at the time of Norwood discharge. Prolonged hospitalization and greater number of discharge medications at the time of Norwood discharge were associated with tube feeding. Infants with SRV who were able to feed orally had a higher WAZ pre- stage II than those fed only via tubes (after adjusting for clinical site). Exploring strategies to promote optimal nutrition in this highest risk population is warranted.
Congenital Cardiology Solutions FEEDING PRACTICE VARIATION AND PREDICTORS OF INFANT WEIGHT FOLLOWING THE NORWOOD PROCEDURE: A REPORT FROM THE PEDIATRIC HEART NETWORK SINGLE VENTRICLE RECONSTRUCTION TRIAL ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: The Single Ventricle Abstract Category: 27. Congenital Cardiology Solutions: Pediatric Presentation Number: 1133-37 Authors: Linda M. Lambert, Nancy Pike, Barbara Medoff-Cooper, victor zak, Victoria Pemberton, Lisa Young-Borkowski, Martha Clabby, Kathryn Nelson, Richard Ohye, Bethany Trainor, Karen Uzark, Nancy Rudd, Louise Bannister, Rosalind Korsin, David Cooper, christian Pizarro, Sinai Zyblewski, Bronwyn Bartle, Richard Williams, Pediatric Heart Network Investigators, Primary Children’s Medical Center, Salt Lake City, UT, USA Background: Poor growth in infants with single right ventricle anomalies (SRV) following the Norwood procedure is associated with significant morbidity. No single feeding strategy has emerged as “best practice” to improve weight gain. We sought to assess center differences in feeding practice at the time of Norwood hospital discharge, predictors of tube feeding, and associations between site, feeding mode, and growth prior to stage II palliation. Methods: From May 2005 to July 2008, 555 subjects were enrolled from 15 centers in the Pediatric Heart Network Single Ventricle Reconstruction Trial; 432 survivors with feeding data at discharge following the Norwood were included in this analysis. Statistical analyses included ANOVA for weight-for-age z-score (WAZ) vs. feeding mode at Norwood discharge and clinical site. Univariate and multivariable logistic regression were used to examine patient and clinical factors associated with tube feeding. Results: Feeding mode was compared among 4 groups: oral only (n=140), oral/tube (n=195), nasogastric tube (NG) only (n=40), and gastrostomy tube (GT) only (n=57). There was significant variation in feeding mode among sites (oral only 0-81% and GT only 0-56%, p<0.01). After adjusting for clinical site, final multivariable regression model showed that GT feeding only is associated with longer hospitalization, while NG feeding only is associated with greater number of discharge medications (R2=0.65, p<0.01). After adjusting for site, mean pre-stage II WAZ was significantly higher in the oral only group (-1.4) vs. the NG only (-2.2) and GT only (-2.1) groups (p=0.04 and 0.02, respectively). There were significant differences in the change in WAZ from Norwood discharge to pre-stage II among sites (p<0.01). Conclusions: Feeding mode varied among centers at the time of Norwood discharge. Prolonged hospitalization and greater number of discharge medications at the time of Norwood discharge were associated with tube feeding. Infants with SRV who were able to feed orally had a higher WAZ pre- stage II than those fed only via tubes (after adjusting for clinical site). Exploring strategies to promote optimal nutrition in this highest risk population is warranted.