Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Abstract

Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15?0.50, p<0.001) and sepsis (0.29, 0.13?0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66?0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69?0.97, p=0.018) and any BF (0.71, 0.57?0.89, p=0.003) experienced shorter LOS. Conclusions: Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants.

Human milk, breastfeeding, and early neurodevelopmental outcomes for infants with critical CHD

“…Our findings of associations between direct breastfeeding and higher Bayley-IV scores are unique, as we did not identify any previous studies focused specifically on breastfeeding and neurodevelopmental outcomes in hospitalised infants. However, skin-toskin maternal contact may improve preterm neurodevelopmental outcomes, 19 and direct breastfeeding confers some differential benefits for hospitalised neonates (e.g., improved gut microbiome, 20 reduced sepsis 11 ). It is possible that infants who did not breastfeed were more critically ill.…”

“…9 There is limited evidence about human milk and breastfeeding in the context of critical CHD, 10 and relationships between human milk and neurodevelopment for these infants are currently unknown. A recent study 11 of 2491 infants with single ventricle CHD demonstrated that human milk feeding and direct breastfeeding substantially reduced inflammatory diseases known to impact neurodevelopment (e.g., 72% lower necrotising enterocolitis; 93% lower sepsis). To our knowledge, however, no previous study has investigated relationships between human milk/breastfeeding and neurodevelopment for infants with critical CHD.…”