Open Access

ARTICLE

Longitudinal growth in patients with single ventricle cardiac disease receiving tube‐assisted feeds

Arene Butto¹, Laura Mercer‐Rosa¹, Christopher Teng¹, Carrie Daymont², Jonathan Edelson¹, Jennifer Faerber¹, Erika Mejia¹, Chitra Ravishankar¹, Meryl S. Cohen¹

1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2 Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania

* Corresponding Author:Arene Butto, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104. Email:

Congenital Heart Disease 2019, 14(6), 1058-1065. https://doi.org/10.1111/chd.12843

Abstract

Objective: Children with single ventricle cardiac disease (SVCD) have poor growth in early life. Tube‐assisted feeding (TF) is used to improve weight gain, but its impact on long‐term growth remains unknown. We sought to compare the longitudinal growth of SVCD patients receiving TF after initial cardiac surgery with those fed entirely by mouth.
Design: We conducted a retrospective cohort study of SVCD patients who under‐ went initial surgical palliation between 1999 and 2009. We defined TF as the use of nasogastric, gastrostomy, or jejunostomy TF. We compared maximal attained growth z‐scores for each year of life between TF and non‐TF patients. A secondary analysis compared surgical and clinical factors between groups.
Results: A total of 134 patients were included; 64% were male and 68% underwent the Norwood operation. One third of patients (44) received TF. Adjusting for age, TF patients had an average of 0.56 lower weight‐for‐age z‐score (WAZ) than non‐TF patients (P = 0.007) through the age of 6 years. Longitudinal height was not affected by TF status (P = 0.15). In a subanalysis of Norwood patients, TF patients had lower WAZ at initial hospital discharge despite longer LOS. TF patients had diminished WAZ after adjusting for complications, interstage hospitalizations, and timing of sub‐ sequent operations.
Conclusions: In this single‐center study, patients with SVCD requiring TF at discharge from initial surgical palliation had diminished WAZ at discharge and on long‐term fol‐ low‐up, despite controlling for other identifiable risk factors. Further investigation is needed to understand the mechanisms underlying this phenomenon and to risk stratify infants who go home on TF.

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