Impact of Palliation Strategy on Interstage Feeding and Somatic Growth for Infants With Ductal-Dependent Pulmonary Blood Flow: Results from the Congenital Catheterization Research Collaborative

• Type of Material: Article
• Authors: George T. Nicholson, Vanderbilt University; Andrew C. Glatz, University of Pennsylvania; Athar M. Qureshi, Texas Children's Hospital; Christopher Petit, Emory University; Jeffery J. Meadows, University of California San Francisco; Courtney McCracken, Emory University; Michael Kelleman, Emory University; Holly Bauser-Heaton, Emory University; Ari J. Gartenberg, University of Pennsylvania; R. Allen Ligon, Emory University; Varun Aggarwal, Texas Children’s Hospital; Derek B. Kwakye, University of Cincinnati; Bryan H. Goldstein, University of Cincinnati
• Language: English
• Date: 2020-01-07
• Publisher: Wiley
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.119.013807
• Title of Journal or Parent Work: Journal of the American Heart Association
• Volume: 9
• Issue: 1
• Start Page: e013807
• End Page: e013807
• Grant/Funding Information: This study was funded in part by generous support from the member institutions of the Congenital Catheterization Research Collaborative as well as the Kennedy Hammill Pediatric Cardiac Research Fund, The Liam Sexton Foundation, and A Heart Like Ava.
• Keywords: CHILDHOOD; WEIGHT-GAIN; HEART-DISEASE; CHILDREN; CLINICAL-OUTCOMES; TERM; outcomes research; PRETERM INFANTS; surgery; congenital heart disease; Cardiovascular System & Cardiology; SINGLE VENTRICLE PHYSIOLOGY; NUTRITIONAL-STATUS; Science & Technology; Cardiac & Cardiovascular Systems; Life Sciences & Biomedicine; BLALOCK-TAUSSIG SHUNT
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

In infants with ductal-dependent pulmonary blood flow, the impact of palliation strategy on interstage growth and feeding regimen is unknown. Methods and Results: This was a retrospective multicenter study of infants with ductal-dependent pulmonary blood flow palliated with patent ductus arteriosus (PDA) stent or Blalock-Taussig shunt (BTS) from 2008 to 2015. Subjects with a defined interstage, the time between initial palliation and subsequent palliation or repair, were included. Primary outcome was change in weight-for-age Z-score. Secondary outcomes included % of patients on: all oral feeds, feeding-related medications, higher calorie feeds, and feeding-related readmission. Propensity score was used to account for baseline differences. Subgroup analysis was performed in 1- (1V) and 2-ventricle (2V) groups. The cohort included 66 PDA stent (43.9% 1V) and 195 BTS (54.4% 1V) subjects. Prematurity was more common in the PDA stent group (P=0.051). After adjustment, change in weight-for-age Z-score did not differ between groups over the entire interstage. However, change in weight-for-age Z-score favored PDA stent during the inpatient interstage (P=0.005) and BTS during the outpatient interstage (P=0.032). At initial hospital discharge, PDA stent treatment was associated with all oral feeds (P<0.001) and absence of feeding-related medications (P=0.002). Subgroup analysis revealed that 2V but not 1V patients demonstrated significant increase in weight-for-age Z-score. In the 2V cohort, feeding-related readmissions were more common in the BTS group (P=0.008). Conclusions: In infants with ductal-dependent pulmonary blood flow who underwent palliation with PDA stent or BTS, there was no difference in interstage growth. PDA stent was associated with a simpler feeding regimen and fewer feeding-related readmissions.