title: Effect of feeding modality on interstage growth after stage I palliation: a report from the National Pediatric Cardiology Quality Improvement Collaborative.
abstract: OBJECTIVE
  Achieving adequate growth after stage 1 palliation for children with single-ventricle heart defects often requires supplemental nutrition through enteral tubes. Significant practice variability exists between centers in the choice of feeding tube. The impact of feeding modality on the growth of patients with a single ventricle after stage 1 palliation was examined using the multiinstitutional National Pediatric Cardiology Quality Improvement Collaborative data registry.
  
  
  METHODS
  Characteristics of patients were compared by feeding modality, defined as oral only, nasogastric tube only, oral and nasogastric tube, gastrostomy tube only, and oral and gastrostomy tube. The impact of feeding modality on change in weight for age z-score during the interstage period, from stage 1 palliation discharge to stage 2 palliation, was evaluated by multivariable linear regression, adjusting for important patient characteristics and postoperative morbidities.
  
  
  RESULTS
  In this cohort of 465 patients, all groups demonstrated improved weight for age z-score during the interstage period with a mean increase of 0.3±0.8. In multivariable analysis, feeding modality was not associated with differences in the change in weight for age z-score during the interstage period (P=.72). Risk factors for poor growth were a diagnosis of hypoplastic left heart syndrome (P=.003), vocal cord injury (P=.007), and lower target caloric goal at discharge (P=.001).
  
  
  CONCLUSIONS
  In this large multicenter cohort, interstage growth improved for all groups and did not differ by feeding modality. With appropriate caloric goals and interstage monitoring, adequate growth may be achieved regardless of feeding modality and therefore local comfort and complication risk should dictate feeding modality.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis. Electronic address: ghill@chw.org.
authors.forename: Garick D
authors.initials: GD
authors.lastname: Hill
authors.affiliation: Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: David A
authors.initials: DA
authors.lastname: Hehir
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Division of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bartz
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rudd
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Frommelt
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Julie
authors.initials: J
authors.lastname: Slicker
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Jena
authors.initials: J
authors.lastname: Tanem
authors.affiliation: Division of Speech and Audiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Katherine
authors.initials: K
authors.lastname: Frontier
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Qun
authors.initials: Q
authors.lastname: Xiang
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Ghanayem
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D008297:Male; D058327:Norwood Procedures; D018529:Nutritional Support / Q000379:methods*; D010166:Palliative Care; D011184:Postoperative Period; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015430:Weight Gain