Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry
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, len...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030756 |
| _version_ | 1797689820100689920 |
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| author | Kristin M. Elgersma Julian Wolfson Jayne A. Fulkerson Michael K. Georgieff Wendy S. Looman Diane L. Spatz Kavisha M. Shah Karen Uzark Anne Chevalier McKechnie |
| author_facet | Kristin M. Elgersma Julian Wolfson Jayne A. Fulkerson Michael K. Georgieff Wendy S. Looman Diane L. Spatz Kavisha M. Shah Karen Uzark Anne Chevalier McKechnie |
| author_sort | Kristin M. Elgersma |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T01:50:58Z |
| format | Article |
| id | doaj.art-1880e18e9052491f8114a9e1edb97387 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T01:50:58Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1880e18e9052491f8114a9e1edb973872023-09-08T12:39:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-09-01121710.1161/JAHA.123.030756Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC RegistryKristin M. Elgersma0Julian Wolfson1Jayne A. Fulkerson2Michael K. Georgieff3Wendy S. Looman4Diane L. Spatz5Kavisha M. Shah6Karen Uzark7Anne Chevalier McKechnie8University of Minnesota School of Nursing Minneapolis MN USADivision of Biostatistics University of Minnesota School of Public Health Minneapolis MN USAUniversity of Minnesota School of Nursing Minneapolis MN USADepartment of Pediatrics University of Minnesota Medical School Minneapolis MN USAUniversity of Minnesota School of Nursing Minneapolis MN USAUniversity of Pennsylvania School of Nursing Philadelphia PA USADepartment of Pediatrics University of Minnesota Medical School Minneapolis MN USADivision of Cardiac Surgery University of Michigan Medical School Ann Arbor MI USAUniversity of Minnesota School of Nursing Minneapolis MN USABackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.123.030756breast feedingcongenital heart defectshypoplastic left heart syndromehuman milkinfant |
| spellingShingle | Kristin M. Elgersma Julian Wolfson Jayne A. Fulkerson Michael K. Georgieff Wendy S. Looman Diane L. Spatz Kavisha M. Shah Karen Uzark Anne Chevalier McKechnie Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease breast feeding congenital heart defects hypoplastic left heart syndrome human milk infant |
| title | Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry |
| title_full | Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry |
| title_fullStr | Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry |
| title_full_unstemmed | Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry |
| title_short | Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry |
| title_sort | human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease propensity score matched analysis of the npc qic registry |
| topic | breast feeding congenital heart defects hypoplastic left heart syndrome human milk infant |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030756 |
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