title: Association of feeding modality with interstage mortality after single-ventricle palliation.
abstract: OBJECTIVE
  Interstage mortality has been reported in 10% to 25% of hospital survivors after single-ventricle palliation. The purpose of this study was to examine the impact of feeding modality at discharge after single-ventricle palliation on interstage mortality.
  
  
  METHODS
  We conducted a retrospective review of all neonates undergoing single-ventricle palliation from January 2003 to January 2010. A total of 334 patients (90%) survived to hospital discharge, comprising the study group. Preoperative, operative, and postoperative variables were examined, including feeding method at discharge. Multivariate Poisson regression models were constructed to estimate the relative risk of interstage mortality.
  
  
  RESULTS
  Of 334 patients, 56 (17%) underwent gastrostomy tube ± Nissen. There was a statistically significant increase in interstage mortality for patients who underwent gastrostomy tube ± Nissen compared with patients who did not (relative risk, 2.38; 95% confidence interval, 1.05-5.40; P = .04]). Of the 278 patients who were not fed via a gastrostomy tube ± Nissen, 190 (68%) were fed with nasogastric feedings and 88 (32%) were fed entirely by mouth. There was no difference in interstage mortality between these 2 groups (relative risk, 0.92; 95% confidence interval, 0.31-2.73; P = .89).
  
  
  CONCLUSIONS
  Neonates undergoing single-ventricle palliation who require gastrostomy tube ± Nissen are at an increased risk of interstage mortality. The need for gastrostomy tube ± Nissen in this population may be a marker for other unmeasured comorbidities that place them at an increased risk of interstage mortality. Discharge with nasogastric feeds does not increase the risk of interstage mortality.
authors.affiliation: Sibley Heart Center, Children's Healthcare of Atlanta, Ga., USA. chebson@emory.edu
authors.forename: Camden L
authors.initials: CL
authors.lastname: Hebson
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.forename: Martha L
authors.initials: ML
authors.lastname: Clabby
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wulkan
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
mesh_terms: D058366:Blalock-Taussig Procedure; D016009:Chi-Square Distribution; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology; D005774:Gastrostomy; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D010166:Palliative Care; D016012:Poisson Distribution; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015430:Weight Gain