Human Milk and Direct Breastfeeding for Infants with Single Ventricle Congenital Heart Disease: An Analysis of Prevalence, Supportive and Limiting Factors, and Impact on Key Outcomes

项目摘要/摘要 先天性心脏病(CHD)是最常见的先天性畸形，每100名婴儿中就有1人受到影响。 喂养是这些婴儿主要关注的领域，因为喂养问题与糟糕的外科手术有关。 与心脏疾病相比，家庭更关心儿童的健康和发育结果。婴儿患有 单心室(SV)先天性心脏病经历了一系列3个阶段的儿童期手术， 与进食有关的发病率和死亡率。尽管喂养对患有SV的婴儿的结局起着关键作用 冠心病，这方面的研究是有限的。母乳喂养(父母自己的母乳或捐赠者的母乳)和直接喂养 母乳喂养(通过乳房插销哺乳)已被认为是一种特别需要 为推动实践和政策提供高质量的证据。最有力的证据支持纯母乳 由于坏死性小肠结肠炎风险降低，喂养是一种挽救生命的干预措施。直接母乳喂养 支持喂养期间的心肺稳定，改善母乳喂养持续时间，并被 大多数分娩的人。然而，目前仅有1例先天性心脏病婴儿纯母乳喂养的报道。 (在第一阶段姑息手术[S1P]出院时有15%)，直接母乳喂养率未知。从 有限的数据，这些婴儿似乎距离2030年健康人口42.4%的目标相去甚远 母乳喂养6个月。这项研究的目的是解决关于以下方面的关键知识差距 先天性心脏病婴儿的母乳喂养和直接母乳喂养。具体地说，本研究旨在：1) 确定新生儿先天性心脏病期间母乳喂养和直接母乳喂养的流行率 S1P住院、S1P出院时和第二阶段姑息手术(S2P)；2)确定以下因素 与母乳喂养和直接母乳喂养呈正相关和负相关 S2P；以及3)估计母乳喂养和直接母乳喂养对以下关键结果的影响程度 婴儿先天性心脏病，包括坏死性小肠结肠炎，术后并发症，完全喂养的时间 容量、住院时间、计划外再入院和死亡率。研究目标将通过以下方式实现 来自《国家儿科心脏病学刊》的一篇多站点注册(样本量~2000)的二次分析 改进协作(~60个站点)，由2016-2021年的数据组成。在这项研究完成后， 我们希望对这些喂养做法的当前比率有更清楚的了解；确定 支持性和限制性因素；以及与关键结果的明确关联。这项研究具有重要意义 因为它有可能为这一领域亟需的临床指南提供信息，并可能支持我们长期的- 学期研究的目标是开发响应文化的、以家庭为中心的干预措施，以改善低发病率 为患有各种形式的先天性心脏病的婴儿提供母乳喂养和直接母乳喂养。鉴于已知的好处 母乳喂养和对其他脆弱新生儿人群的直接母乳喂养，增加了 这些做法有可能改善先天性心脏病婴儿的健康和发育。

PROJECT SUMMARY/ABSTRACT Congenital heart disease (CHD) is the most common congenital anomaly, affecting nearly 1 in 100 infants. Feeding is a primary area of concern for these infants, as feeding problems are associated with poor surgical and developmental outcomes and are often more concerning to families than the cardiac condition. Infants with single ventricle (SV) CHD undergo a series of 3 staged childhood surgeries and are at particularly high risk for feeding-related morbidity and mortality. Despite the key role feeding plays in outcomes for infants with SV CHD, research in this area is limited. Human milk feeding (parent’s own milk or donor human milk) and direct breastfeeding (human milk via a latch at the breast) have been identified as practices particularly in need of high-quality evidence to drive practice and policy. The strongest evidence supports exclusive human milk feeding as a life-saving intervention due to reduced risk for necrotizing enterocolitis. Direct breastfeeding supports cardiorespiratory stability during feeding, improves human milk feeding duration, and is preferred by most birthing persons. However, only 1 report of exclusive human milk feeding for infants with SV CHD exists (15% at stage 1 palliation surgery [S1P] discharge), and rates of direct breastfeeding are unknown. From the limited data, it appears these infants are far from the Healthy People 2030 objective of 42.4% exclusive breastfeeding through 6 months. The purpose of this study is to address the critical gap in knowledge about human milk feeding and direct breastfeeding for infants with SV CHD. Specifically, this study aims to: 1) Determine the prevalence of human milk feeding and direct breastfeeding for infants with SV CHD during the S1P hospitalization, at S1P discharge, and at stage 2 palliation surgery (S2P); 2) Identify factors that are positively and negatively associated with human milk feeding and direct breastfeeding at S1P discharge and at S2P; and 3) Estimate the effect size of human milk feeding and direct breastfeeding on key outcomes for infants with SV CHD, including necrotizing enterocolitis, postoperative complications, time to full feeding volume, length of stay, unplanned readmission, and mortality. The study aims will be accomplished through secondary analysis of a multisite registry (sample size ~2000) from the National Pediatric Cardiology Quality Improvement Collaborative (~60 sites), which consists of data from 2016–2021. At the completion of this study, we expect to have gained a clearer understanding of current rates of these feeding practices; identified supportive and limiting factors; and determined associations with key outcomes. This study is significant because it has the potential to inform much-needed clinical guidelines in this area, and could support our long- term research goal of developing culturally-responsive, family-centered interventions that improve the low rates of human milk feeding and direct breastfeeding for infants with all forms of CHD. Given the known benefits of human milk feeding and direct breastfeeding for other vulnerable neonatal populations, increasing the rates of these practices has the potential to improve the health and development of infants with SV CHD.