607: Outcomes of Feeding Intolerance and Nec in Single-Ventricle Infants After Bypass Surgery

Abstract

INTRODUCTION:Cardiopulmonary Bypass (CPB) is associated with systemic inflammation, reduction of intestinal perfusion, microcirculatory alterations, and loss of intestinal barrier integrity, which may lead to feeding intolerance and necrotizing enterocolitis (NEC). We hypothesize that postsurgical infants with single ventricle physiology and feeding intolerance and/or NEC would have higher mortality, hospital costs and longer hospital stays. METHODS: Retrospective cohort of Single VentriclePatients less than 1 year old inpatient Texas DSHS, 2017-2019. Primary outcome was mortality, secondary outcomes included gastrointestinal surgical interventions, hospital charges and length of stay (LOS). Frequentist analysis and multivariate regression were performed.RESULTS: 2,628 patients with single ventricle physiology were identified, 518 (19.7%) had a diagnosis of feeding intolerance, and 54 (2.1%) had a diagnosis of NEC. Prematurity was associated with NEC, 26.1% vs 11.9%, p 0.004. Feeding intolerance and NEC were more frequent in patients older than 1 month old, p < 0.001. 171 (6.5%) had an abdominal surgery. NEC was associated with intestinal resection, 5.6% vs 0.7%, p 0.008. Feeding intolerance was associated with insertion of a feeding tube, 6% vs 2.8%, p < 0.001. NEC was not associated with mortality. Patients with Feeding intolerance (FI) had lower odds of mortality in a multivariate model, OR 0.5 (95% CI 0.34-0.76). In survivors, the LOS was longer in patients with FI and/or NEC, mean difference 24 days, p < 0.001. Charges for patients with FI and/or NEC were higher, mean difference USD$ 365,237, p < 0.001. CONCLUSIONS:Post CPB surgery, infants with single ventricle physiology with a diagnosis of feeding intolerance and/or NEC were not associated to higher mortality. However, they have prolonged hospital stays and higher total hospital charges.