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.
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.
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DOI：
10.1161/jaha.123.030756
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发表时间：
2023-09-05
影响因子：
5.4
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中科院分区：
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患有单心室先天性心脏病的婴儿接受3期手术/干预，存在发病率和死亡率风险。我们评估了母乳（HM）和直接母乳喂养对结局的影响，包括坏死性小肠结肠炎、感染相关并发症、住院时间和死亡率。我们分析了国家儿科心脏病质量改进合作（NPC‐QIC）登记研究（2016-2021），检查了第1阶段和第2阶段缓解期间的HM/母乳喂养组。我们计算了进食暴露的倾向评分，然后拟合泊松和逻辑回归模型，以比较倾向匹配队列之间的结果。参与者包括2491名婴儿（68个站点）。HM/母乳喂养组的所有结局估计值均更好。在第1阶段姑息治疗（S1 P）前喂养纯HM的婴儿术前坏死性小肠结肠炎的几率较低（比值比[OR]，0.37 [95%CI，0.17-0.84]; P=0.017），S1 P住院时间较短（率比[RR]，0.87 [95%CI，0.78-0.98]; P=0.027）。在S1 P住院期间，高HM的婴儿术后坏死性小肠结肠炎的几率较低（OR，0.28 [95%CI，0.15-0.50]; P<0.001）和脓毒症（OR，0.29 [95%CI，0.13-0.65]; P=0.003），和较短的S1 P住院时间（RR，0.75 [95%CI，0.66-0.86]; P<0.001）。在第2阶段缓解期，任何HM（RR，0.82 [95% CI，0.69-0.97]; P=0.018）和任何母乳喂养（RR，0.71 [95% CI，0.57-0.89]; P=0.003）的婴儿的住院时间较短。高HM组和母乳喂养组中患有单心室先天性心脏病的婴儿经历了多个显著更好的结局。鉴于我们的研究结果，改善健康，战略，以提高HM/母乳喂养率在这些患者中应实施。未来的研究应该用颗粒喂养数据和更广泛的先天性心脏病人群复制这些发现，并应该检查HM/母乳喂养对这些婴儿有益的机制（例如HM成分，微生物组）。
Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection‐related complications, length of stay, and mortality. We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC‐QIC) registry (2016–2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity‐matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17–0.84]; P=0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78–0.98]; P=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15–0.50]; P<0.001) and sepsis (OR, 0.29 [95% CI, 0.13–0.65]; P=0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66–0.86]; P<0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69–0.97]; P=0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57–0.89]; P=0.003) experienced shorter length of stay. Infants with single ventricle congenital heart disease in high‐HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.