Open Access

Feeding methods for infants with single ventricle physiology are associated with length of stay during stage 2 surgery hospitalization

by

1 Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
2 Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
3 Johns Hopkins Biostatistics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
4 Department of Pediatrics, Otolaryngology, Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland

* Corresponding Author: Maureen A. Lefton‐Greif, The Eudowood Division of Pediatric Respiratory Sciences, 200 N. Wolfe Street, Baltimore, MD 21287. Email:

Congenital Heart Disease 2019, 14(3), 438-445. https://doi.org/10.1111/chd.12742

Abstract

Background: Tube feedings are often needed to achieve the growth and nutrition goals associated with decreased morbidity and mortality in patients with single ventricle anat‐ omy. Variability in feeding method through the interstage period has been previously described, however, comparable information following stage 2 palliation is lacking.
Objectives: To identify types of feeding methods following stage 2 palliation and their influence on length of stay.
Design: Secondary analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry was performed on 932 patients. Demographic data, medical characteristics, postoperative complications, type of feeding method, and length of stay for stage 2 palliation were analyzed.
Results: Type of feeding method remained relatively unchanged during hospitalization for stage 2 palliation. Gastrostomy tube fed only patients were the oldest at time of surgery (182.7 ± 57.7 days, P < .001) and had the lowest weight‐for‐age z scores at ad‐ mission (−1.6 ± 1.4, P < .001). Oral + gastrostomy tube groups had the longest median bypass times (172.5 minutes, P = .001) and longest length of stay (median 12 days, P < .001). Multivariable modeling revealed that feeding by tube only (P < .001), oral + tube feeding (P ≤ .001), reintubation (P < .001), and prolonged intubation (P < .001) were associated with increased length of stay. Neither age (P = .156) nor weight‐for‐age z score at admission (P = .066) was predictive of length of stay.
Conclusions: Feeding methods established at admission for stage 2 palliation are not likely to change by discharge. Length of stay is more likely to be impacted by tube feeding and intubation history than age or weight‐for‐age z score at admission. Better understanding for selection of feeding methods and their impact on patient out‐ comes is needed to develop evidence‐based guidelines to decrease variability in clini‐ cal practice patterns and provide appropriate counseling to caregivers.

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