TY - JOUR
T1 - Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease
T2 - Propensity Score-Matched Analysis of the NPC-QIC Registry
AU - Elgersma, Kristin M.
AU - Wolfson, Julian
AU - Fulkerson, Jayne A.
AU - Georgieff, Michael K.
AU - Looman, Wendy S.
AU - Spatz, Diane L.
AU - Shah, Kavisha M.
AU - Uzark, Karen
AU - McKechnie, Anne Chevalier
N1 - Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/9/5
Y1 - 2023/9/5
N2 - BACKGROUND: Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection-related complications, length of stay, and mortality. METHODS AND RESULTS: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016– 2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17– 0.84]; P=0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78– 0.98]; P=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15–0.50]; P<0.001) and sepsis (OR, 0.29 [95% CI, 0.13– 0.65]; P=0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66–0.86]; P<0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69– 0.97]; P=0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57– 0.89]; P=0.003) experienced shorter length of stay. CONCLUSIONS: Infants with single ventricle congenital heart disease in high-HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.
AB - BACKGROUND: Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection-related complications, length of stay, and mortality. METHODS AND RESULTS: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016– 2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17– 0.84]; P=0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78– 0.98]; P=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15–0.50]; P<0.001) and sepsis (OR, 0.29 [95% CI, 0.13– 0.65]; P=0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66–0.86]; P<0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69– 0.97]; P=0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57– 0.89]; P=0.003) experienced shorter length of stay. CONCLUSIONS: Infants with single ventricle congenital heart disease in high-HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.
KW - breast feeding
KW - congenital heart defects
KW - human milk
KW - hypoplastic left heart syndrome
KW - infant
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UR - http://www.scopus.com/inward/citedby.url?scp=85169847643&partnerID=8YFLogxK
U2 - 10.1161/JAHA.123.030756
DO - 10.1161/JAHA.123.030756
M3 - Article
C2 - 37642030
AN - SCOPUS:85169847643
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
M1 - e030756
ER -
