Randomized Controlled Trial

. 2014 Feb;164(2):237-42.e1.

doi: 10.1016/j.jpeds.2013.09.042. Epub 2013 Nov 6.

Variation in feeding practices following the Norwood procedure

Linda M Lambert¹, Nancy A Pike², Barbara Medoff-Cooper³, Victor Zak⁴, Victoria L Pemberton⁵, Lisa Young-Borkowski⁶, Martha L Clabby⁷, Kathryn N Nelson⁸, Richard G Ohye⁹, Bethany Trainor¹⁰, Karen Uzark¹¹, Nancy Rudd⁶, Louise Bannister¹², Rosalind Korsin¹³, David S Cooper¹⁴, Christian Pizarro¹⁵, Sinai C Zyblewski¹⁶, Bronwyn H Bartle¹⁷, Richard V Williams¹⁸; Pediatric Heart Network Investigators

Collaborators, Affiliations

Collaborators

Pediatric Heart Network Investigators:
Gail Pearson, Victoria Pemberton, Rae-Ellen Kavey, Mario Stylianou, Marsha Mathis, Lynn Mahony, Lynn Sleeper, Sharon Tennstedt, Steven Colan, Lisa Virzi, Patty Connell, Victoria Muratov, Lisa Wruck, Minmin Lu, Dianne Gallagher, Anne Devine, Julie Schonbeck, Thomas Travison, David F Teitel, Jane W Newburger, Peter Laussen, Pedro del Nido, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, John E Mayer Jr, Frank Pigula, Emile A Bacha, Francis Fynn-Thompson, Wyman Lai, Beth Printz, Daphne Hsu, William Hellenbrand, Ismee Williams, Ashwin Prakash, Seema Mital, Ralph Mosca, Darlene Servedio, Rozelle Corda, Rosalind Korsin, Mary Nash, Victoria L Vetter, Sarah Tabbutt, J William Gaynor, Chitra Ravishankar, Thomas Spray, Meryl Cohen, Marisa Nolan, Stephanie Piacentino, Sandra DiLullo, Nicole Mirarchi, D Woodrow Benson, Catherine Dent Krawczeski, Lois Bogenschutz, Teresa Barnard, Michelle Hamstra, Rachel Griffiths, Kathryn Hogan, Steven Schwartz, David Nelson, Pirooz Eghtesady, A W Anderson, Jennifer Li, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Scott Bradley, Eric Graham, Teresa Atz, Patricia Infinger, L LuAnn Minich, John A Hawkins-deceased, Michael Puchalski, Richard V Williams, Peter C Kouretas, Linda M Lambert, Marian E Shearrow, Jun A Porter, Brian McCrindle, Joel Kirsh, Chris Caldarone, Elizabeth Radojewski, Svetlana Khaikin, Susan McIntyre, Nancy Slater, Caren S Goldberg, Richard G Ohye, Cheryl Nowak, Nancy S Ghanayem, James S Tweddell, Kathleen A Mussatto, Michele A Frommelt, Peter C Frommelt, Lisa Young-Borkowski, Alan Lewis, Vaughn Starnes, Nancy Pike, Jeffrey P Jacobs, James A Quintessenza, Paul J Chai, David S Cooper, J Blaine John, James C Huhta, Tina Merola, Tracey Griffith, William Mahle, Kirk Kanter, Joel Bond, Jeryl Huckaby, Christian Pizarro, Carol Prospero, Julie Simons, Gina Baffa, Wolfgang A Radtke, Ilana Zeltzer, Tia Tortoriello, Deborah McElroy, Deborah Town, John Rhodes, J Curt Fudge, Peter Frommelt, Gerald Marx, Catherine Stolle, Michael Artman, Erle Austin, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, Rae-Ellen Kavey, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb

Affiliations

¹ Primary Children's Medical Center, Salt Lake City, UT. Electronic address: Linda.lambert@imail.org.
² University of California, Los Angeles, CA.
³ University of Pennsylvania, School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA.
⁴ New England Research Institutes, Watertown, MA.
⁵ National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD.
⁶ Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
⁷ Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
⁸ University of Michigan, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
⁹ University of Michigan School of Medicine, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
¹⁰ Boston Children's Hospital, Boston, MA.
¹¹ Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
¹² The Hospital for Sick Children, Toronto, Ontario, Canada.
¹³ Columbia University, New York, NY.
¹⁴ Congenital Heart Institute of Florida, Orlando, FL.
¹⁵ Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE.
¹⁶ Medical University of South Carolina, Charleston, SC.
¹⁷ Duke University, Durham, NC.
¹⁸ University of Utah School of Medicine, Salt Lake City, UT.

PMID: 24210923
PMCID: PMC3946861
DOI: 10.1016/j.jpeds.2013.09.042

Randomized Controlled Trial

Variation in feeding practices following the Norwood procedure

Linda M Lambert et al. J Pediatr. 2014 Feb.

. 2014 Feb;164(2):237-42.e1.

doi: 10.1016/j.jpeds.2013.09.042. Epub 2013 Nov 6.

Authors

Collaborators

Pediatric Heart Network Investigators:
Gail Pearson, Victoria Pemberton, Rae-Ellen Kavey, Mario Stylianou, Marsha Mathis, Lynn Mahony, Lynn Sleeper, Sharon Tennstedt, Steven Colan, Lisa Virzi, Patty Connell, Victoria Muratov, Lisa Wruck, Minmin Lu, Dianne Gallagher, Anne Devine, Julie Schonbeck, Thomas Travison, David F Teitel, Jane W Newburger, Peter Laussen, Pedro del Nido, Roger Breitbart, Jami Levine, Ellen McGrath, Carolyn Dunbar-Masterson, John E Mayer Jr, Frank Pigula, Emile A Bacha, Francis Fynn-Thompson, Wyman Lai, Beth Printz, Daphne Hsu, William Hellenbrand, Ismee Williams, Ashwin Prakash, Seema Mital, Ralph Mosca, Darlene Servedio, Rozelle Corda, Rosalind Korsin, Mary Nash, Victoria L Vetter, Sarah Tabbutt, J William Gaynor, Chitra Ravishankar, Thomas Spray, Meryl Cohen, Marisa Nolan, Stephanie Piacentino, Sandra DiLullo, Nicole Mirarchi, D Woodrow Benson, Catherine Dent Krawczeski, Lois Bogenschutz, Teresa Barnard, Michelle Hamstra, Rachel Griffiths, Kathryn Hogan, Steven Schwartz, David Nelson, Pirooz Eghtesady, A W Anderson, Jennifer Li, Wesley Covitz, Kari Crawford, Michael Hines, James Jaggers, Theodore Koutlas, Charlie Sang Jr, Lori Jo Sutton, Mingfen Xu, J Philip Saul, Andrew Atz, Girish Shirali, Scott Bradley, Eric Graham, Teresa Atz, Patricia Infinger, L LuAnn Minich, John A Hawkins-deceased, Michael Puchalski, Richard V Williams, Peter C Kouretas, Linda M Lambert, Marian E Shearrow, Jun A Porter, Brian McCrindle, Joel Kirsh, Chris Caldarone, Elizabeth Radojewski, Svetlana Khaikin, Susan McIntyre, Nancy Slater, Caren S Goldberg, Richard G Ohye, Cheryl Nowak, Nancy S Ghanayem, James S Tweddell, Kathleen A Mussatto, Michele A Frommelt, Peter C Frommelt, Lisa Young-Borkowski, Alan Lewis, Vaughn Starnes, Nancy Pike, Jeffrey P Jacobs, James A Quintessenza, Paul J Chai, David S Cooper, J Blaine John, James C Huhta, Tina Merola, Tracey Griffith, William Mahle, Kirk Kanter, Joel Bond, Jeryl Huckaby, Christian Pizarro, Carol Prospero, Julie Simons, Gina Baffa, Wolfgang A Radtke, Ilana Zeltzer, Tia Tortoriello, Deborah McElroy, Deborah Town, John Rhodes, J Curt Fudge, Peter Frommelt, Gerald Marx, Catherine Stolle, Michael Artman, Erle Austin, Timothy Feltes, Julie Johnson, Thomas Klitzner, Jeffrey Krischer, G Paul Matherne, John Kugler, Rae-Ellen Kavey, David J Driscoll, Mark Galantowicz, Sally A Hunsberger, Thomas J Knight, Holly Taylor, Catherine L Webb

Affiliations

¹ Primary Children's Medical Center, Salt Lake City, UT. Electronic address: Linda.lambert@imail.org.
² University of California, Los Angeles, CA.
³ University of Pennsylvania, School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA.
⁴ New England Research Institutes, Watertown, MA.
⁵ National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD.
⁶ Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
⁷ Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
⁸ University of Michigan, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
⁹ University of Michigan School of Medicine, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
¹⁰ Boston Children's Hospital, Boston, MA.
¹¹ Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
¹² The Hospital for Sick Children, Toronto, Ontario, Canada.
¹³ Columbia University, New York, NY.
¹⁴ Congenital Heart Institute of Florida, Orlando, FL.
¹⁵ Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE.
¹⁶ Medical University of South Carolina, Charleston, SC.
¹⁷ Duke University, Durham, NC.
¹⁸ University of Utah School of Medicine, Salt Lake City, UT.

PMID: 24210923
PMCID: PMC3946861
DOI: 10.1016/j.jpeds.2013.09.042

Abstract

Objectives: To 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 design: From 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.

Results: Demographic 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).

Conclusions: Feeding 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.

Trial registration: ClinicalTrials.gov NCT00115934.

Keywords: G-tube; Gastrostomy or gastrojejunostomy tube; HLHS; Hypoplastic left heart syndrome; N-tube; Nasojejunal or nasogastric tube; PI; Pediatric Heart Network Single Ventricle Reconstruction Trial; Principal investigator; SVR; WAZ; Weight-for-age z score.

Published by Mosby, Inc.

PubMed Disclaimer

Figures

**Figure**
Weigh-for-Age Z-scores at Baseline, Norwood Discharge, and Prior to Stage

See this image and copyright information in PMC

References

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1. Medoff-Cooper B, Irving SY, Marino BS, Garcia-Espana JF, Ravishankar C, Bird GL, et al. Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge. Cardiol Young. 21:136–44. Epub 2010/11/13. - PubMed
1. Williams RV, Zak V, Ravishankar C, Altmann K, Anderson J, Atz AM, et al. Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial. J Pediatr. 2011;159:1017–22. e2. Epub 2011/07/26. - PMC - PubMed
1. Di Maria MV, Glatz AC, Ravishankar C, Quartermain MD, Rush CH, Nance M, et al. Supplemental Tube Feeding Does Not Mitigate Weight Loss in Infants with Shunt-Dependent Single-Ventricle Physiology. Pediatric cardiology. 2013 Epub 2013/02/21. - PubMed
1. Anderson JB, Beekman RH, 3rd, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg. 2009;138:397–404. e1. Epub 2009/07/22. - PubMed

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Variation in feeding practices following the Norwood procedure

Collaborators

Affiliations

Variation in feeding practices following the Norwood procedure

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous