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Arch intervention following stage 1 palliation in hypoplastic left heart syndrome is associated with slower feed advancement: a report from the National Pediatric Quality Cardiology Improvement Collaborative

Published online by Cambridge University Press:  03 February 2020

Alicia H. Chaves Open the ORCID record for Alicia H. Chaves [Opens in a new window] ,
Carissa M. Baker-Smith  and
Geoffrey L. Rosenthal
Alicia H. Chaves*
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, 110 S Paca Street, 7th Floor, Baltimore, MD21201, USA
Carissa M. Baker-Smith
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, 110 S Paca Street, 7th Floor, Baltimore, MD21201, USA
Geoffrey L. Rosenthal
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, 110 S Paca Street, 7th Floor, Baltimore, MD21201, USA
*
Author for correspondence: A. H. Chaves, MD, University of Maryland School of Medicine, 110 S Paca Street, 7th Floor, Baltimore, MD21201, USA. Tel: +1 410 328 4348; Fax: +1 410 328 8670; E-mail: achaves@som.umaryland.edu
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Abstract

Introduction:

Infants undergoing stage 1 palliation for hypoplastic left heart syndrome may have post-operative feeding difficulties. Although the cause of feeding difficulties in these patients is multi-factorial, residual arch obstruction may affect gut perfusion, contributing to feeding intolerance. We hypothesised that undergoing arch reintervention following stage 1 palliation would be associated with post-operative feeding difficulties.

Methods:

This was a retrospective cohort study. We analysed data from the National Pediatric Cardiology Quality Improvement Collaborative, which maintains a multicentre registry for infants with hypoplastic left heart syndrome discharged home following stage 1 palliation. Patients who underwent arch reintervention (percutaneous or surgical) prior to discharge following stage 1 palliation were compared with those who underwent non-aortic arch interventions after stage 1 palliation and those who underwent no intervention. Median post-operative days to full enteral feeds and weight for age z-scores were compared. Predictors of post-operative days to full feeds were identified.

Results:

Among patients who underwent arch reintervention, post-operative days to full enteral feeds were greater than for those who underwent non-aortic arch interventions (25 versus 16, p = 0.003) or no intervention (median days 25 versus 12, p < 0.001). Arch intervention, multiple interventions, gestational age, and the presence of a gastrointestinal anomaly were predictors of days to full feeds.

Conclusions:

Repeat arch intervention is associated with a longer time to achieve full enteral feeding in patients with hypoplastic left heart syndrome after stage 1 palliation. Further investigation of this association is needed to understand the role of arch obstruction in feeding problems in these patients.

Keywords

Hypoplastic left heart syndromecoarctationstage 1 palliationNorwoodfeeding problems
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 3 , March 2020 , pp. 396 - 401
Copyright
© Cambridge University Press 2020

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