• The Journal of pediatrics · Feb 2014

    Randomized Controlled Trial Multicenter Study Comparative Study

    Variation in feeding practices following the Norwood procedure.

    • Linda M Lambert, Nancy A Pike, Barbara Medoff-Cooper, Victor Zak, Victoria L Pemberton, Lisa Young-Borkowski, Martha L Clabby, Kathryn N Nelson, Richard G Ohye, Bethany Trainor, Karen Uzark, Nancy Rudd, Louise Bannister, Rosalind Korsin, David S Cooper, Christian Pizarro, Sinai C Zyblewski, Bronwyn H Bartle, Richard V Williams, and Pediatric Heart Network Investigators.
    • Primary Children's Medical Center, Salt Lake City, UT. Electronic address: Linda.lambert@imail.org.
    • J. Pediatr. 2014 Feb 1;164(2):237-42.e1.

    ObjectivesTo assess variation in feeding practice at hospital discharge after the Norwood procedure, factors associated with tube feeding, and associations among site, feeding mode, and growth before stage II.Study DesignFrom May 2005 to July 2008, 555 subjects from 15 centers were enrolled in the Pediatric Heart Network Single Ventricle Reconstruction Trial; 432 survivors with feeding data at hospital discharge after the Norwood procedure were analyzed.ResultsDemographic and clinical variables were compared among 4 feeding modes: oral only (n = 140), oral/tube (n = 195), nasogastric tube (N-tube) only (n = 40), and gastrostomy tube (G-tube) only (n = 57). There was significant variation in feeding mode among sites (oral only 0%-81% and G-tube only 0%-56%, P < .01). After adjusting for site, multivariable modeling showed G-tube feeding at discharge was associated with longer hospitalization, and N-tube feeding was associated with greater number of discharge medications (R(2) = 0.65, P < .01). After adjusting for site, mean pre-stage II weight-for-age z-score was significantly higher in the oral-only group (-1.4) vs the N-tube-only (-2.2) and G-tube-only (-2.1) groups (P = .04 and .02, respectively).ConclusionsFeeding mode at hospital discharge after the Norwood procedure varied among sites. Prolonged hospitalization and greater number of medications at the time of discharge were associated with tube feeding. Infants exclusively fed orally had a higher weight-for-age z score pre-stage II than those fed exclusively by tube. Exploring strategies to prevent morbidities and promote oral feeding in this highest risk population is warranted.Published by Mosby, Inc.

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