title: Interstage feeding and weight gain in infants following the Norwood operation: can we change the outcome?
abstract: BACKGROUND
  Poor weight gain is common in infants after Stage I Norwood operation and can negatively impact outcomes.
  
  
  OBJECTIVE
  The purpose of this study was to examine the impact of feeding strategy on interstage weight gain.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics - Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio, United States of America. karenu@med.umich.edu
authors.forename: Karen
authors.initials: K
authors.lastname: Uzark
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Nancy
authors.initials: N
authors.lastname: Rudd
authors.forename: E Marsha
authors.initials: EM
authors.lastname: Elixson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Strawn
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Nieves
authors.forename: Cathy
authors.initials: C
authors.lastname: Smith
authors.forename: Sandra
authors.initials: S
authors.lastname: Staveski
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Brien
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tong
authors.forename: Richard
authors.initials: R
authors.lastname: Ittenbach
mesh_terms: D001835:Body Weight / Q000502:physiology; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal; D007902:Length of Stay / Q000639:trends; D008297:Male; D058327:Norwood Procedures; D018529:Nutritional Support / Q000379:methods*; D010351:Patient Discharge / Q000639:trends; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology*