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Interstage feeding and weight gain in infants following the Norwood operation: can we change the outcome?

Published online by Cambridge University Press:  24 January 2012

Karen Uzark*
Department of Pediatrics – Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Yu Wang
Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Nancy Rudd
Department of Pediatrics – Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, United States of America
E. Marsha Elixson
Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
Jennifer Strawn
Cardiology, Children's Hospital, Omaha, Nebraska, United States of America
Jo Ann Nieves
Cardiology, Miami Children's Hospital, Miami, Florida, United States of America
Cathy Smith
Pediatric Cardiothoracic Surgery, Arnold Palmer Hospital, Orlando, Florida, United States of America
Sandra Staveski
Department of Nursing, Lucile Packard Children's Hospital, Stanford, California, United States of America
Patricia O'Brien
Nursing – Cardiovascular Program, The Children's Hospital, Boston, Massachusetts, United States of America
Elizabeth Tong
Pediatric Cardiology, University of California, San Francisco, California, United States of America
Richard Ittenbach
Division of Biostatistics & Epidemiology, Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Correspondence to: Dr K. Uzark, PhD, CPNP, University of Michigan Mott Children's Hospital, L1242 Women's, SPC 5204, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5204, United States of America. Tel: +1 734 615 9748; Fax: +1 734 232 3744; E-mail:



Poor weight gain is common in infants after Stage I Norwood operation and can negatively impact outcomes.


The purpose of this study was to examine the impact of feeding strategy on interstage weight gain.


In a multi-centre study, 158 infants discharged following the Norwood operation were enrolled prospectively. Weight and feeding data were obtained at 2-week intervals. Differences between feeding regimens in average daily weight gain and change in weight-for-age z-score between Stage I discharge and Stage II surgery were examined.


Discharge feeding regimens were oral only in 52%, oral with tube supplementation in 33%, and by nasogastric/gastrostomy tube only in 15%. There were significant differences in the average daily interstage weight gain among the feeding groups – oral only 25.0 grams per day, oral/tube 21.4 grams per day, and tube only 22.3 grams per day – p = 0.019. Tube-only-fed infants were significantly older at Stage II (p = 0.004) and had a significantly greater change in weight-for-age z-score (p = 0.007). The overall rate of weight gain was 16–32 grams per day, similar to infant norms. The rate of weight gain declined over time, with earlier decline observed for oral- and oral/tube-fed infants (less than 15 grams per day at 5.4 months) in comparison with tube-only-fed infants (less than 15 grams per day at 8.6 months).


Following Stage I Norwood, infants discharged on oral feeding had better average daily weight gain than infants with tube-assisted feeding. The overall weight gain was within the normal limits in all feeding groups, but the rate of weight gain decreased over time, with an earlier decline in infants fed orally.

Original Article
Copyright © Cambridge University Press 2012

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