Use of standardized feeding evaluation following surgery for congenital heart defect improves growth in affected newborns
Certain pediatric cardiology centers use a "bundle" of practices to closely monitor weight gain or loss in newborns with a congenital defect in the left ventricle (hypoplastic left heart syndrome, or HLHS) following stage 1 surgery. Newborns treated in these centers have significantly better growth during the multistage repair process than centers that use fewer interventions, according to a new study. Treatment of this congenital defect, in which the mitral valve and left ventricle do not develop properly and consequently reduce the heart’s ability to pump blood, involves a series of surgeries to improve the heart’s pumping capacity during the infant’s first 4–6 months of life. The researchers compared nutritional practices in 16 centers that enrolled at least four infants with HLHS over a 2-year period, for a total of 132 infants in the study. All of the patients had stage 1 surgical palliation (one of several variants of the Norwood procedure) at a median age of 5 days. During the period just after the stage 1 surgery, 50 percent of the centers used standard feeding evaluation to determine whether the infants could get adequate nutrition orally.
By the time of hospital discharge (a median stay of 31 days), 83 percent of the infants were being fed orally (though 46 percent required a feeding tube). At discharge, 63 percent of the centers sent the infants home with scales to monitor daily weight and weight changes, 63 percent of the centers used specific "red flags" to monitor for early signs of growth failure, and 9 centers did both. The researchers found that optimal growth of infants was associated with centers that used a combination of standard postoperative feeding evaluation before discharge, close weight monitoring after discharge with home scales, and specific weight gain/loss "red flags." Newborns treated in centers using only standard gastrointestinal medications during the period between the surgical stages experienced the worst relative growth. The researchers enrolled patients treated at centers participating in the National Pediatric Cardiology Quality Improvement Collaborative Registry and conducted structured interviews with members of each of the participating surgical sites for details of their nutritional interventions. The study was funded in part by the Agency for Healthcare Research and Quality (HS16957).
More details are in "Variation in growth of infants with a single ventricle," by Jeffrey B. Anderson, M.D., M.P.H., Srikant B. Iyer, M.D., M.P.H., David N. Schidlow, M.D., and others in the July 2012 The Journal of Pediatrics 161(1), pp. 16-21.