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

单心室先天性心脏病婴儿的母乳和直接母乳喂养：患病率、支持和限制因素以及对主要结果的影响分析

• 批准号: 10535335
• 负责人: Kristin M Elgersma
• 金额: $ 4.93万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10535335
• 关键词: Address; Affect; Area; Attention; Birth; Breast; Breast Feeding; Breastfed infant; Cardiac; Childhood; Clinical; Communication; Data; Development; Diagnosis; Disease; Ethnic Origin; Exclusive Breastfeeding; Family; Foundations; Future; Goals; Growth and Development function; Guidelines; Health; Hospitalization; Human Milk; Infant; Infant Development; Infant Mortality; Intervention; Knowledge; Language; Lead; Length of Stay; Life; Linear Models; Milk; Mission; Morbidity - disease rate; Necrotizing Enterocolitis; Neighborhoods; Neonatal; Operative Surgical Procedures; Outcome; Parents; Pediatric cardiology; Persons; Play; Policies; Population; Postoperative Complications; Postoperative Period; Prevalence; Public Health; Race; Recommendation; Registries; Reporting; Research; Risk; Sample Size; Sampling; Savings; Series; Single ventricle congenital heart disease; Site; Socioeconomic Status; Time; Training; Translations; United States National Institutes of Health; Work; career development; clinical practice; congenital anomaly; congenital heart disorder; demographics; disability; feeding; health care disparity; high risk; hospital readmission; improved; infant outcome; mortality; outcome prediction; palliation; secondary analysis; social health determinants

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.

项目总结/摘要 先天性心脏病（CHD）是最常见的先天性异常，影响近1/100的婴儿。 喂养是这些婴儿关注的主要领域，因为喂养问题与不良的外科手术有关。 和发展结果，往往比心脏病更令家庭关注。婴幼儿 单心室（SV）CHD经历了一系列3期儿童手术， 喂养相关的发病率和死亡率。尽管喂养在SV婴儿的结局中起着关键作用， CHD，这方面的研究有限。母乳喂养（父母自己的母乳或供体母乳）和直接 母乳喂养（通过乳房上的闩锁母乳）已被确定为特别需要 高质量的证据来推动实践和政策。最有力的证据支持纯母乳 喂养作为一种挽救生命的干预措施，因为降低了坏死性小肠结肠炎的风险。直接母乳喂养 支持喂养期间的心肺稳定性，改善母乳喂养持续时间， 大多数生育的人然而，只有1份报告的纯母乳喂养的婴儿与SV冠心病存在 (15 1期姑息手术[S1 P]出院时的%），直接母乳喂养率未知。从 由于数据有限，这些婴儿似乎远远没有达到2030年健康人口目标的42.4%。 母乳喂养6个月。这项研究的目的是解决知识的关键差距， 母乳喂养和直接母乳喂养的SV CHD婴儿。具体而言，本研究旨在：1） 确定2010年期间SV CHD婴儿母乳喂养和直接母乳喂养的流行率。 S1 P住院、S1 P出院和第2阶段姑息手术（S2 P）; 2）确定 与S1 P出院时母乳喂养和直接母乳喂养呈正相关和负相关， S2 P;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大小： SV CHD婴儿，包括坏死性小肠结肠炎，术后并发症，至完全喂养时间 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质量管理局的多中心登记研究（样本量约2000）的二次分析 Improvement Collaborative（约60个研究中心），包含2016-2021年的数据。在本研究完成时， 我们希望能够更清楚地了解这些喂养方法的当前比率;确定 支持性和限制性因素;以及与关键结果的确定关联。这项研究意义重大 因为它有可能为这一领域急需的临床指南提供信息，并可以支持我们长期的- 长期的研究目标是制定文化敏感，以家庭为中心的干预措施，改善低利率 母乳喂养和直接母乳喂养的婴儿患有各种形式的CHD。鉴于已知的好处， 母乳喂养和其他弱势新生儿群体的直接母乳喂养， 这些实践具有改善患有SV CHD的婴儿的健康和发育的潜力。

项目成果

Patterns of Breastfeeding and Human Milk Feeding in Infants with Single-Ventricle Congenital Heart Disease: A Population Study of the National Pediatric Cardiology Quality Improvement Collaborative Registry.

单心室先天性心脏病婴儿的母乳喂养和母乳喂养模式：国家儿科心脏病质量改进合作登记处的人口研究。

• DOI: 10.1089/bfm.2023.0036
• 发表时间: 2023
• 期刊: Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine
• 作者: Elgersma,KristinM;Spatz,DianeL;Fulkerson,JayneA;Wolfson,Julian;Georgieff,MichaelK;Looman,WendyS;Shah,KavishaM;Uzark,Karen;McKechnie,AnneChevalier
• 通讯作者: McKechnie,AnneChevalier

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.

• DOI: 10.1161/jaha.123.030756
• 发表时间: 2023-09-05
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4

An mHealth, patient engagement approach to understand and address parents' mental health and caregiving needs after prenatal diagnosis of critical congenital heart disease.

• DOI: 10.1016/j.pecinn.2023.100213
• 发表时间: 2023-12-15
• 期刊: PEC innovation
• 作者: McKechnie, Anne Chevalier;Elgersma, Kristin M;Iwaszko Wagner, Taylor;Trebilcock, Anna;Damico, Jenna;Sosa, Alejandra;Ambrose, Matthew B;Shah, Kavisha;Sanchez Mejia, Aura A;Pridham, Karen F
• 通讯作者: Pridham, Karen F