title: Variation in feeding practices following the Norwood procedure.
abstract: OBJECTIVE
  To assess variation in feeding practice at hospital discharge after the Norwood procedure, factors associated with tube feeding, and associations among site, feeding mode, and growth before stage II.
  
  
  METHODS
  From May 2005 to July 2008, 555 subjects from 15 centers were enrolled in the Pediatric Heart Network Single Ventricle Reconstruction Trial; 432 survivors with feeding data at hospital discharge after the Norwood procedure were analyzed.
  
  
  RESULTS
  Demographic and clinical variables were compared among 4 feeding modes: oral only (n = 140), oral/tube (n = 195), nasogastric tube (N-tube) only (n = 40), and gastrostomy tube (G-tube) only (n = 57). There was significant variation in feeding mode among sites (oral only 0%-81% and G-tube only 0%-56%, P < .01). After adjusting for site, multivariable modeling showed G-tube feeding at discharge was associated with longer hospitalization, and N-tube feeding was associated with greater number of discharge medications (R(2) = 0.65, P < .01). After adjusting for site, mean pre-stage II weight-for-age z-score was significantly higher in the oral-only group (-1.4) vs the N-tube-only (-2.2) and G-tube-only (-2.1) groups (P = .04 and .02, respectively).
  
  
  CONCLUSIONS
  Feeding mode at hospital discharge after the Norwood procedure varied among sites. Prolonged hospitalization and greater number of medications at the time of discharge were associated with tube feeding. Infants exclusively fed orally had a higher weight-for-age z score pre-stage II than those fed exclusively by tube. Exploring strategies to prevent morbidities and promote oral feeding in this highest risk population is warranted.
authors.affiliation: Primary Children's Medical Center, Salt Lake City, UT. Electronic address: Linda.lambert@imail.org.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Lambert
authors.affiliation: University of California, Los Angeles, CA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Pike
authors.affiliation: University of Pennsylvania, School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Medoff-Cooper
authors.affiliation: New England Research Institutes, Watertown, MA.
authors.forename: Victor
authors.initials: V
authors.lastname: Zak
authors.affiliation: National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Pemberton
authors.affiliation: Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Lisa
authors.initials: L
authors.lastname: Young-Borkowski
authors.affiliation: Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Clabby
authors.affiliation: University of Michigan, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Nelson
authors.affiliation: University of Michigan School of Medicine, C. S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, MI.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Trainor
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Karen
authors.initials: K
authors.lastname: Uzark
authors.affiliation: Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Nancy
authors.initials: N
authors.lastname: Rudd
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Bannister
authors.affiliation: Columbia University, New York, NY.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Korsin
authors.affiliation: Congenital Heart Institute of Florida, Orlando, FL.
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.affiliation: Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Sinai C
authors.initials: SC
authors.lastname: Zyblewski
authors.affiliation: Duke University, Durham, NC.
authors.forename: Bronwyn H
authors.initials: BH
authors.lastname: Bartle
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Williams
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D058327:Norwood Procedures; D010351:Patient Discharge / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain
keywords: G-tube; Gastrostomy or gastrojejunostomy tube; HLHS; Hypoplastic left heart syndrome; N-tube; Nasojejunal or nasogastric tube; PI; Pediatric Heart Network Single Ventricle Reconstruction Trial; Principal investigator; SVR; WAZ; Weight-for-age z score