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Oral Feeding Is Associated with Improved Weight Gain In Infants with Shunt-Dependent Single Ventricle Physiology

Saturday, October 20, 2012: 8:45 AM
Room 275-277 (Morial Convention Center)
Michael V. Di Maria, M.D.1, Andrew C. Glatz1, Michael D. Quartermain2, Michael L. Nance3, Chitra Ravishankar1, J. William Gaynor1 and David J. Goldberg1, (1)Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Pediatrics, Wake Forest University, Winston-Salem, NC, (3)Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA

Purpose: Infants with shunt-dependent single ventricle (SV) physiology are at risk for poor weight gain prior to Stage 2 palliation.  Lower weight for age z-score is a risk factor for prolonged hospital stay after Stage 2.  We evaluated the impact of mode of feeding on inter-stage weight gain.

Methods: A chart review was performed of all infants with shunt-dependent single ventricle physiology born between 8/07 and 9/10 who survived to hospital discharge after initial palliation.  Z-scores were calculated based on World Health Organization data.

Results:

Table 1.  Differences based on type of feeding regimen at hospital discharge following initial shunt or Stage 1 palliation

Total (n=135)

PO (n=53, 39.3%)

NG (n=57, 42.2%)

GT (n=25, 18.5%)

Mean ±SD

Mean ±SD

Mean ±SD

Mean ±SD

p-value

Gender, male

84 (62%)

32 (60%)

33 (58%)

19 (76%)

0.28

Norwood operation

102 (76%)

32 (60%)

48 (84%)

22 (88%)

0.004

Extracardiac anomaly

34 (25%)

14 (26%)

12 (21%)

8 (32%)

0.556

Length of hospital stay (days)

27.9 ±32.9

15.9 ±8.5

27.3 ±36.8

54.5 ±40.9

<0.0001

Birth weight (kg)

3.15 ±0.56

3.22 ±0.54

3.09 ±0.62

3.16 ±0.44

0.47

Birth weight z-score

-0.41 ±1.23

-0.25 ±1.15

-0.58 ±1.38

-0.4 ±0.98

0.39

Weight at discharge (kg)

3.43 ±0.79

3.41 ±0.55

3.29 ±0.79

3.82 ±1.09

0.02

Weight at discharge (z-score)

-1.77 ±1.28

-1.31 ±1.16

-1.86 ±1.29

-2.56 ±1.13

0.0001

Change in weight z-score from birth to discharge

-1.35 ±0.73

-1.05 ±0.56

-1.27 ±0.61

-2.17 ±0.72

<0.0001

Weight at Stage 2 (kg)

6.1 ±1.1

6.63 ±1.13

5.68 ±0.98

5.9 ±0.85

0.0001

Weight at Stage 2 (z-score)

-1.77 ±1.24

-1.13 ±1.15

-2.15 ±1.14

-2.29 ±1.08

<0.0001

Change in weight z-score from discharge to Stage 2

-0.05 ±1.2

0.13 ±1.17

-0.33 ±1.22

0.22 ±1.19

0.09

Interstage mortality

17 (13%)

6 (12%)

8 (14%)

3 (13%)

0.93

Age at Stage 2 (days)

164.9 ±38.6

170 ±38.1

158 ±41

166 ±33.6

0.34

Birth weight z-score did not differ among the three groups (p=0.47).  However, infants fed by nasogastric or gastrostomy tube were smaller than orally fed infants at hospital discharge (p=0.0001), a difference that persisted through Stage 2 (p<0.0001).  Infants who underwent a Norwood-type reconstruction were more likely to receive NG or G-tube feeds (p=0.004). Interstage mortality and age at Stage 2 did not differ among the three groups.

Conclusion: Infants with shunt-dependent SV physiology have significant weight loss from birth to initial hospital discharge. Growth failure persists in the interstage period before stage 2, and is not mitigated by tube feeds. Growth failure in this patient population is likely multifactorial, and close monitoring of nutritional status should continue in the interstage period.