(8 - Friday) Early breastfeeding is associated with increased odds of later human milk feeding for infants with single ventricle congenital heart disease: Analysis of the NPC-QIC registry
Objective: Infants with single ventricle congenital heart disease (SV CHD) often experience feeding challenges, which negatively impact surgical and developmental outcomes and are stressful for families. Emerging evidence demonstrates that human milk feeding (HMF) may benefit these infants, but research is limited.
Our objective was to determine HMF and direct breastfeeding prevalence from birth through stage 2 surgery (S2) discharge, and to test the hypothesis that direct breastfeeding at neonatal stage 1 surgery (S1) discharge was associated with increased odds of any type of HMF at subsequent S2.
Methods: We performed secondary analysis of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016–2021) using descriptive statistics and adjusted logistic regression. HMF and direct breastfeeding were measured: (a) before S1 (n=2491; median/IQR age at surgery 6/4–8 days), (b) at S1 discharge (n=1946; 39/28–58 days), (c) preoperatively at S2 (n=1849; 144/123–175 days), and (d) at S2 discharge (n=1741; 162/139–193 days).
Results: HMF prevalence ranged from 49.3% (any HMF) and 41.5% (exclusive HMF) before S1 to 37.1% (any) and 7.0% (exclusive) preoperatively at S2. Direct breastfeeding prevalence ranged from 16.1% (any) and 7.9% (exclusive) before S1 to 9.2% (any) and 3.2% (exclusive) at S2 discharge. Prevalence varied among NPC-QIC sites at all time points; for example, the prevalence of any HMF before S1 ranged from 0%–100% across sites.
In adjusted logistic regression, infants directly breastfeeding at S1 discharge had 4.11 times greater odds of any HMF at S2 (95% CI, 2.79–6.07, p< 0.001), and 1.85 times greater odds of exclusive HMF at S2 (95% CI, 1.03–3.30, p=0.039).
Conclusions: Prevalence of HMF and direct breastfeeding for infants with SV CHD was low and declined over time. Direct breastfeeding at S1 discharge was associated with increased odds of any HMF at S2. Wide variation across sites suggests that site-specific practices impact feeding outcomes. HMF and direct breastfeeding prevalence are suboptimal in this population, and future research can target identification of supportive institutional practices during the S1 hospitalization.
