The Impact of Human Milk on Outcomes for Infants with Congenital Heart Disease: A Systematic Review

Wayfinding through the “ocean of the great unknown”: how lactating parents establish a direct breastfeeding relationship with an infant with critical CHD

“…Concerningly, some parents described being actively misinformed by their healthcare team, receiving messages that human milk is not safe for infants with critical CHD or that breastfeeding is more work for these infants than bottle feeding. These types of statements conflict with available evidence, which demonstrates that exclusive human milk feeding confers benefits including a reduced risk of necrotising enterocolitis in this population 5 and that, as the American Heart Association explains in its online patient education, “the ‘work’ of breastfeeding is actually less than the work of bottle feeding.” 9,38 Especially considering that infant feeding holds deep moral and relational meaning for parents, it is ethically objectionable for healthcare teams to dissuade families from pursuing human milk or breastfeeding goals based on opinions that contradict previous evidence.…”

“…2 Feeding challenges contribute to suboptimal direct breastfeeding prevalence in this population, with rates as low as 3.2% (exclusive) at 6 months. 3 Emerging evidence demonstrates that human milk may be a "life-saving intervention" 4 for infants with CHD due to lowered risk for necrotising enterocolitis 5 a devastating disease with 19-26% mortality in CHD. 6 Providing human milk via direct breastfeeding reduces early human milk weaning in term and preterm infants, 7,8 allows greater cardiorespiratory stability while feeding, 9 offers personalised immunological benefits, [10][11][12] and is preferred by most birthing persons.…”

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

“…Yu et al 87 found that infants fed HM had a 3.9 days shorter mean length of stay compared to a formula feeding group in a cohort with varied CHD diagnoses; however, this study exhibits high risk of bias. 15 We did not identify any studies examining direct BF and length of stay for infants with surgical congenital anomalies. The preterm literature similarly focuses primarily on HM feeding as a nutritional entity rather than on the mode of feeding, although Suberi et al 88 reported an association between direct BF as the first mode of oral feeding (compared to bottle) for preterm infants and ~1 week earlier NICU discharge.…”

“…14 Inadequate lactation support could be reflective of limited evidence about HM/BF for this population. 9,15 Human milk and BF positively impact outcomes including NEC, 16 sepsis, 17 length of stay, 18 and mortality 19 for preterm infants and infants with surgical gastrointestinal anomalies. Little is known, however, about the benefits of HM and BF for infants with CHD.…”

“…22 However, most studies of HM for infants with CHD are limited by small sample size, heterogenous diagnoses, or risk for statistical bias. 15 Only one study 21 has examined HM and outcomes for infants specifically with SV physiology, focusing on the impact of an HM-based fortifier on weight gain. To our knowledge, there is no evidence focused on direct BF and outcomes for infants with CHD of any type.…”