Impact of breast milk composition on nutritional status of term neonates with congenital heart defects: A prospective study

Table 1 Clinical characteristics of term neonates with congenital heart defects

	Operated (n = 25)	Non-operated (n = 10)	P value
Birth weight (g)	3340.0 (3130.0-3620.0)	3640.0 (3227.5-3895.0)	0.201
WAZ at birth	0.07 (-0.28-0.55)	0.72 (-0.25-1.36)	0.228
IUGR	1 (4.0)	1 (10.0)	0.524
Gestational age, weeks	39.6 (39.0-40.0)	40.00 (39.1-40.4)	0.687
Male neonates, female neonates	13, 12	3, 7	0.285
Age of mother (years)	29.0 (25.0-33.0)	31.00 (23.0-36.5)	0.609
Mothers from North Caucasian ethnic groups	14 (56.0)	4 (40.0)	0.471
Cesarean section	6 (24.0)	1 (10.0)	0.644
Gestational diabetes	1 (4.0)	3 (30.0)	0.061
Preeclampsia	2 (8.0)	2 (20.0)	0.561
Age at surgery, DOL	6.0 (5.0-8.5)
Aristotle score	7.0 (6.0-10.0)
Palliative surgery	7 (28.0)
Operation duration (minute)	240.0 (185.0-305)
Cardiopulmonary bypass	18 (72.0)
Cardiopulmonary bypass duration, min	115.0 (0.0-180.5)
Max. VIS 0-24 h after surgery	15.0 (5.0-21.0)
Max. VIS 24-48 h after surgery	8.0 (5.0-16.5)
Length of inotropic therapy, days	2.0 (1.0-4.5)
Length of assisted ventilation, days	2.0 (1.0-4.0)
Extracorporeal membrane oxygenation
Days in NICU after surgery	5.0 (4.0-9.0)
Discharge from NICU, DOL	13.0 (10.0-15.0)
Start of enteral feeding after surgery (POD)	1.0 (1.0-1.0)
Pneumonia (during hospital stay), N	10 (40.0)	3 (30.0)	0.709
NEC (during hospital stay)	6 (24.0)	1 (10.0)	0.644
Full enteral feeding		9.00 (3.2-14.8)	0.002
DOL	22.0 (16.0-32.0)
POD	8.5 (15.0-26.0)
RBC transfusions, from birth to discharge (except intraoperative)	10 (40.0)	0 (0.0)	0.034
Transfer to mother’s ward, DOL	28.0 (20.0-34.0)	10.0 (5.3-15.7)	0.003
Start of BM feeding postoperatively
DOL	16.0 (13.0-28.0)
POD	11.00 (5.0-19.0)
Discharge, DOL	33.5 (27.0-37.5)	20.50 (17.2-27.0)	0.015
Discharge, POD	26.00 (16.0-31.0)

Data are presented as n (%)/median (25^th-75^th percentiles). WAZ: Weight-for-age z score; IUGR: Intrauterine growth retardation; VIS: Vasoactive inotropic score; NICU: Neonatal intensive care unit; NEC: Necrotizing enterocolitis; RBC: Red blood cells; DOL: Day of life; POD: Postoperative day.

Table 2 Associations of variables with delta of weight-for-age z score from the preoperative period to discharge in operated neonates with congenital heart defects

	Univariable regression
	Coefficient	Standard error	T	P >|t|
General characteristics and postoperative morbidities
WAZ at birth	-0.36	0.68	-0.53	0.599
Gestational age, (weeks)	-0.69	0.65	-1.06	0.299
Length ABT preoperatively (days)	-0.72	0.44	-1.65	0.113
Length ABT postoperatively (days)	-2.26	0.46	-4.94	0.001
Full EF, POD	-2.32	0.41	-5.60	0.001
Pneumonia postoperatively1	-0.67	0.31	-2.17	0.041
NEC postoperatively1	-0.15	0.39	-0.39	0.699
Regurgitation postoperatively1	-0.81	0.48	-1.68	0.106
Day of surgery	-0.41	0.64	-0.64	0.528
Days in NICU	-1.98	0.62	-3.20	0.004
Transfer to mother’s ward, POD	-1.97	0.52	-3.82	0.001
Days of hospitalization postoperatively	-2.26	0.44	-5.10	0.001
Total intake on POD 14
Fat (g/kg/day)	1.58	0.71	2.23	0.036
Protein (g/kg/day)	-0.77	0.60	-1.28	0.214
Carbohydrates (g/kg/day)	-0.79	0.47	-1.69	0.106
Energy (kcal/kg/day)	1.61	0.78	2.08	0.049
EF volume (mL/kg/day)	1.05	0.46	2.28	0.032
Total intake before surgery
Fat (g/kg/day)	0.31	0.75	0.42	0.679
Protein (g/kg/day)	0.05	0.66	0.07	0.945
Carbohydrates (g/kg/day)	0.08	0.88	0.09	0.927
Energy (kcal/kg/day)	0.17	0.65	0.26	0.797
EF volume DOL 7 (mL/kg/day)	1.03	0.53	1.93	0.066
Perioperative characteristics
Aristotle score	-0.69	0.55	-1.27	0.217
Bypass length (minutes)	-0.65	0.48	-1.35	0.190
Operation length (minutes)	-0.47	0.61	-0.78	0.442
VIS 0-24 h postoperatively, max	-0.74	0.57	-1.31	0.203
VIS 24-48 h postoperatively, max	-1.72	0.72	-2.40	0.025
Inotropes length (days)	-1.76	0.68	-2.57	0.017
Ventilation length (days)	-2.05	0.62	-3.32	0.003
Shunt (BTS/Norwood/DKS)1	-1.33	0.36	-3.74	0.001
Bypass1	-0.73	0.36	-2.05	0.051
Delayed sternal closure1	-0.61	0.35	-1.73	0.097
Feeding intolerance, early postoperatively	-0.87	0.34	-2.52	0.019
RBC transfusions1	-0.57	0.32	-1.82	0.082
Mature mother’s milk composition
Fat (g/100 mL)	-0.69	0.78	-0.90	0.378
Total protein (g/100 mL)	0.80	0.78	1.02	0.318
True protein (g/100 mL)	0.93	0.79	1.17	0.254
Carbohydrates (g/100 mL)	-0.17	0.78	-0.23	0.824
Energy (kcal/100 mL)	-0.60	0.76	-0.79	0.436
Characteristics of feeding with mother’s milk
HMF/preterm formula postoperatively1	-0.82	0.33	-2.51	0.020
Mean weight gain in BM feeding postoperatively (g/day)	1.25	0.73	1.71	0.101
Start of BM feeding, POD	-1.97	0.50	-3.98	0.001
BM feeding only, POD	-2.21	0.45	-4.91	0.001
Days of BM preoperatively	-0.82	0.68	-1.22	0.236
Days BM postoperatively	-1.26	0.57	-2.21	0.037
BM feeding, % of POD	0.41	0.58	0.71	0.485
BM feeding, % of hospitalization	0.23	0.65	0.34	0.734
	Multivariable regression
Length ABT postoperatively (days)	-1.18	0.54	-2.17	0.041
Full EF, POD	-1.54	0.53	-2.94	0.008

¹Indicates the presence of the condition, coded as a binary variable. WAZ: Weight-for-age z score; Length ABT: Duration of antibacterial treatment; EF: Enteral feeding; DOL: Day of life; POD: Postoperative day; NEC: Necrotizing enterocolitis; NICU: Neonatal intensive care unit; VIS: Vasoactive inotropic score; BTS: Modified Blalock-Taussig shunt; DKS: Damus–Kaye–Stansel procedure; RBC: Red blood cells; HMF: Human milk fortification; BM: Breast milk.