Breastfeeding and growth in infants with congenital heart disease

Trabulsi, Jillian C.Congenital Heart Disease (CHD), the most common form of birth defects in infants, encompasses structural defects of the interior walls, valves, arteries, and/or veins of the heart, which result in abnormal blood flow and impaired cardiac function. For infants with complex CHD, multiple surgical interventions are common within the first year of life. Additionally, these infants often have feeding difficulties and insufficient energy intake, which in turn lead to growth failure. Breastfeeding, the gold standard for infant nutrition, was historically discouraged in this population as it was considered too physiologically laborious. Despite research demonstrating otherwise and the recommendation that infants with CHD be breastfed, misperceptions remain regarding breastfeeding and growth in this population. The purpose of this study was to describe the impact of breastfeeding and other feeding practices on growth outcomes in infants with CHD during the first year of life. Infants with CHD (N=75) who underwent neonatal cardiac surgery within the first two weeks of life were recruited from The Children’s Hospital of Philadelphia. Data on infant feeding practices (breast milk, infant formula) and anthropometric measures were collected via nine points of contact spread throughout the first year of life. Cluster analysis of feeding type in the first year of life revealed 3 diet patterns: predominantly breast milk, breast milk transitioning to a mix of breast milk/infant formula, and breast milk transitioning to predominantly infant formula. Generalized estimating equations (GEE) that included diet pattern, time, and their interaction were used to determine if growth trajectories differed by diet pattern. The proportion of infants with CHD in each diet pattern was as follows: 39.5% (n=26) were fed ‘predominantly breast milk,’ 31.8% (n=21) were fed ‘breast milk and transitioned to a mix of breast milk/infant formula,’ and 28.7% (n=19) were fed ‘breast milk and transitioned to predominantly infant formula.’ For growth z-score trajectories in the first year of life, we found no significant group x time interactions in weight-for-age (p=0.072), length-for-age (p=0.256), head circumference-for-age (p=0.082), and weight-for-length (p=0.213), indicating infant growth did not differ over time by diet pattern. In conclusion, infants with complex CHD who are predominantly fed breast milk have growth outcomes similar to other diet patterns, and breastfeeding should continue to be encouraged in this population.University of Delaware, Department of Behavioral Health and NutritionM.S