Feeding infants with congenital heart disease with breast milk: Findings from the Norwegian Mother and Child Cohort Study

Feeding infants with congenital heart disease with breast milk: Findings from the Norwegian Mother and Child Cohort Study

Bente Silnes Tandberg (1), Margarete Vollrath (2,3), Eivind Ystrom (2), Henrik Holmstrøm (4) 1. Nursing Profession Centre, Division of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway 2. Department of Psychosomatics and Health Behavior, Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway 3. Psychological Institute, University of Oslo, Norway 4. Unit of Paediatric Cardiology, Division of Paediatrics, Oslo University Hospital, Rikshospitalet, Norway

Background WHO and the Norwegian government recommend breastfeeding, or mother`s own expressed milk, exclusively until the infant has reached six months of age Infants with CHD have challenges regarding nutrition, development and growth Nutritional status is an important predictor of outcome for this group

Aim Explore the occurrence of breast milk feeding among infants with CHD the first six months of age, compared to the general population This study is, to the best of our knowledge, the first population based birth cohort study of this kind

Data from the Norwegian Mother and Child Cohort Study (MoBa) Recruitment at prenatal routine ultrasound (GA 17 18 w) 3 questionnaires before birth Post partum, questionnaire on 6, 18 and 36 months. One questionnaire to fathers

Data from MoBA, MFR, BERTE The control group consisted of all participants in MoBa study without heart defects (n= 65764). The Medical Birth Registry registers information from all births in Norway, (marital status, the pregnancy, the maternal health, the birth, and the child) Registry of congenital heart defects (BERTE): Contains data on diagnoses, interventions, surgery and clinical outcome

Participants and attrition

The CHD patients Mild congenital heart disease (n=112) Generally asymptomatic and without need of treatment Most common defects are insignificant left to right shunts and minor valvar anomalies These heart defects do not affect feeding patterns. Moderate/severe congenital heart disease (n=142) In need of treatment and/or follow up Often symptomatic and feeding is commonly affected. CHD and co-morbidity (n=69) All kinds of heart defects in addition to serious conditions with anticipated influence on the child s development, including feeding (eg. Down s syndrome, brain damage or gastrointestinal malformations)

Categorization of Breastfeeding (WHO,1999). 1. Predominant breastfeeding: feeding without any supplements of formula milk or solid food (but allowing fruit juice and sugared water). 2. Complementary breast milk: is defined as continued breastfeeding, supplemented by formula milk or solids. 3. Bottle-feeding: is defined as feeding of formula milk by bottle, with possible supplements of solids but no breast milk.

1,0 Termination of breast milk feeding Present of feeding with breast milk 0,9 0,8 0,7 0,6 Mod-Severe CHD + Co-Morb Control Cox regression analyses show how mothers of infants with moderate-severe CHD and infants with CHD and comorbidity finish giving breast milk. Differences against the control group are significant (p<0.05) at all time points, except at one month for children with CHD. 0,5 0 1 2 3 4 5 6 months of age

Study limitations MoBa: no information about the mode of feeding of the child. Selective attrition of participants may have resulted in bias towards more capable and efficacious mothers.

Conclusion First population based cohort study on breast milk feeding among infants with CHD Mothers of children with CHD finish giving breast milk earlier than the general population, and even more so to children with CHD and co-morbidity Nevertheless, 74 % of children with CHD receive breast milk at six months of age, as compared to 84 % in the general population Guidance, inherent structures and culture may influence the occurrence of breastfeeding even among infants with special needs

Suggested future studies Investigate the problems mothers encounter when giving breast milk to their infant with CHD Coping mechanisms and the reasons why feeding breast milk is being gradually abandoned. Interventions specifically targeted at mothers of infants with CHD and for those with CHD and co morbidity.