Impact of Breastfeeding and Mother’s Breastmilk on the Postoperative Outcome of Children with Univentricular Hearts

Background: There are rarely any studies exploring the effect of breastmilk on infants in pediatric cardiology. The aim of this retrospective study was to review the impact of breastfeeding versus feeding of breastmilk per bottle or gastral tube versus formula feeding on the postoperative outcome of children with univentricular hearts. Additionally, it was investigated, in which phases of the hospital stay an increase of formula feeding occurred.

Methods: The study included all infants diagnosed with and treated for an univentricular heart in the University Hospital of Cologne born between January 2015 to December 2022. The hospital database search resulted in the inclusion of 125 children who had already undergone the first (Norwood or AP-shunt) and second palliation (PCPC). Six postoperative parameters were analyzed: duration of the weaning of sedatives, duration of the weaning from ventilation, duration of parenteral nutrition, incidences of postoperative infections, length of ICU stay, and total length of hospital stay. Nutrition was classified into three groups: >90% breastmilk, <10% breastmilk, and between. The correlation between the amount of breastmilk and the outcome parameter was statistically analyzed.

Results: Breastmilk had a positive impact on the total length of hospital stay during the first palliation (p = 0.039). Patients receiving >90% breastmilk had an average hospitalization of 20.7 versus 27.7 days for patients receiving <10% breastmilk. Infants fed with 10 to 90% breastmilk had the longest hospital stay (29.8 days). Additionally, the study showed a positive impact of breastmilk feeding on sedative weaning during first palliation (p = 0.051). At the second palliation, we were unable to demonstrate a benefit of breast milk over formula for any of the parameters studied, probably caused by the lack of data for feeding between first and second palliation and the inequality of the group sizes. The proportion of children who were fed more than 90% with breast milk rose from 24.8% postnatally to a maximum of 44% postoperative (first palliation), with a decline to 25.6% at discharge. Preoperatively, 30% of breastmilk-nourished infants were breastfed, at discharge 28.8%. During the stay in the intensive care unit, only one child was breastfed at all.

Conclusion: Feeding breastmilk has a positive impact on the postoperative course of infants with univentricular hearts and should be promoted. Breastfeeding and pumping of breastmilk during hospital stays should be made more accessible. Early education on the positive effects and the establishment of donor milk banks should be considered.

Table 1 Measurements

Variable	Normoxia median (IQR)	Hypoxia median (IQR)	p-Value
Systolic CBP (mm Hg)	94 (92–102)	98 (93–104)	0.852
Diastolic CBP (mm Hg)	67 (64–71)	71 (67–79)	0.023
cfPWV (m/s)	4.4 (4.08–4.97)	4.6 (4.12–5.50)	0.018
AIX (%)	−7 (−14–4)	−18 (−28.50 to −5)	0.006
Aging index	−0.68 (−0.80 to −0.36)	−0.87 (−1.02 to 0.52)	0.035
Right CRVE (μm)	248 (240–262)	269 (251–278)	<0.001
Right CRAE (μm)	218 (210–228)	227 (216–237)	0.001
Right arteriovenous ratio	0.88 (0.82–0.93)	0.86 (0.78–0.91)	0.024

Abbreviations: AIX, augmentation index; CBP, central blood pressure; cfPWV, carotid-femoral pulse-wave velocity; CRAE, central retinal arteriolar equivalent; CRVE, central retinal venular equivalent.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025