O1022: Feeding Variation Among Infants in Acute Care Cardiology Units: A Report from the Pediatric Acute Care Cardiology Collaborative (PAC3)

Background: Infants with congenital and acquired heart disease are at high risk of feeding difficulties and complications due to altered hemodynamics and cardiac interventions. Feeding practices in acute care cardiology units are not standardized. The Pediatric Acute Care Cardiology Collaborative (PAC3) Registry collects detailed feeding data on all infants admitted to a participating center. The objective of this study is to describe current feeding practices at the time of discharge from a PAC3 center and practice variation between centers.

Methods: All infants in the PAC3 registry between February 2019 and October 2021 were included. Data were collected at the encounter level. Nutrition at discharge was summarized with descriptive statistics. Feeding routes at discharge including oral, nasogastric tube, gastrostomy tube, or other (Total Parenteral Nutrition or post-pyloric feeds) were summarized as row percentage and compared using Chi-square or Kruskal-Wallis. Center variation was assessed using funnel plots with control limits set at the 99.9% confidence interval from the group mean. Funnel plots demonstrate control limits based on the group mean and center specific volume. Centers that fall outside of the confidence interval are 3.3 standard deviations from the group mean.

Results: A total of 15,414 encounters across 24 PAC3 centers were recorded from 8,313 unique patients (median encounters 1, range 1-25). Nutrition at encounter discharge consisted of standard formula in 8,368 (54%), human milk in 6,300 (41%), and elemental formula in 3,230 (21%), either alone or in combination. Feeds were fortified to ≥24 kcal/oz in 12,359 (80%) with a median caloric intake of 96 kcal/kg/day (IQR 78.5, 113). Patients were discharged on supplemental tube feeds in 7,353 (48%) of encounters. Of patients discharged with feeding tubes, 4,643 (63%) received continuous feeds, 2,144 (29%) bolus feeds, and 566 (8%) a combination. Variation in feeding route at discharge exists based on gender, age, race, discharge weight for age Z-score, prematurity, presence of a genetic syndrome, encounter type, and number of ventricles with p< 0.001 for each (Table 1). Variation in discharge feeding route by center are demonstrated in Figure 1 with 10 centers (42%) falling above or below the 99.9% confidence interval from the group mean in oral feeding, 19 (79%) in nasogastric tube feeding, and 16 (67%) in gastrostomy tube feeding.

Conclusion: Infants with heart disease discharged from an acute care unit commonly require high calorie nutrition and supplemental tube feedings. Variation in feeding route at discharge is related to patient characteristics as well as center specific practice with discharge utilization of nasogastric and gastrostomy tubes varying widely between PAC3 centers. Collaborative approaches to identify best practices in feeding strategies are needed.