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

Abstract

Background Infants with single ventricle congenital heart disease (SV CHD) undergo three staged palliative surgeries/interventions and are at risk for morbidity and mortality. Human milk (HM) and direct breastfeeding (BF) benefit other vulnerable neonates, but evidence about HM/BF for infants with SV CHD is limited. We aimed to: (1) Determine HM/BF prevalence; determine whether BF at neonatal stage 1 palliation (S1P) discharge is associated with continued HM feeding at stage 2 palliation (S2P). (2) Identify factors that support or limit HM and BF. (3) Estimate the effect of HM and BF on key health outcomes. MethodsWe analyzed data from the National Pediatric Cardiology Quality Improvement Collaborative Registry (n=2491 infants; n=68 sites; 2016–2021). Analysis involved: (1) Descriptive statistics for prevalence; adjusted logistic regression to examine associations between early BF/later HM. (2) Machine learning to identify key HM/BF predictors. (3) Poisson and logistic regression to compare outcomes between propensity-matched cohorts. Results (1) HM/BF prevalence was low and varied among sites. Infants BF at S1P discharge had 4.11 times greater odds of HM feeding at S2P. (2) The strongest HM/BF predictor domain areas included preoperative feeding, demographics and social determinants of health, feeding route, clinical course, and site. (3) Estimates for all outcomes were better in high HM/BF groups, including significantly lower odds of necrotizing enterocolitis, sepsis, and infection; shorter hospital length of stay; and lower mortality. Conclusions Increasing the dose and duration of HM and BF has strong potential to substantially improve the health outcomes of these vulnerable infants.