Comparison of Feeding, Nutritional, and Procedural Outcomes in Infants with Ductal-Dependent Pulmonary Blood Flow Undergoing Surgical Systemic-to-Pulmonary Artery Shunt Versus Ductal Stenting

Ductal stenting and surgical systemic-to-pulmonary artery shunting (surgical shunt) are alternative strategies to establish pulmonary blood flow in infants with ductal-dependent circulation. The impact of palliation strategy on feeding, nutrition, and neurodevelopment remains unclear. We conducted a single-center retrospective study of 100 infants with ductal-dependent pulmonary blood flow (2017-2024) undergoing surgical shunt (n = 57) or ductal stenting (n = 43). Outcomes included feeding, nutrition, hospital course, and neurodevelopment. Multivariable logistic regression evaluated factors associated with gastrostomy tube (GT) placement. Baseline demographics were similar except for cardiac anatomy. Ductal stent patients reached target enteral feeds post-procedurally sooner (3 vs. 6 days, p < 0.001), had higher discharge weight-for-age z-scores (- 1.30 vs. -1.98, p = 0.02), and smaller declines in growth during hospitalization (p = 0.007). GT placement was less frequent following ductal stenting (26% vs. 51%, p = 0.011), but palliation strategy was not independently associated with GT placement after adjustment (OR 0.43, 95% CI 0.14-1.24, p = 0.12). Oral feeding or breastfeeding within 5 days following palliation was independently associated with lower odds of GT placement (OR 0.24, 95% CI 0.06-0.81, p = 0.03). Ductal stent patients also had shorter mechanical ventilation and ICU stays and required less vasoactive-inotropic support. Total hospital length of stay, need for reintervention, suspected or diagnosed necrotizing enterocolitis, and mortality did not differ significantly between groups. Ductal stenting was associated with improved early post-procedural recovery, faster feeding progression, and better preservation of growth compared with surgical shunt palliation. Although GT placement was less frequent following ductal stenting in unadjusted analysis, palliation strategy was not independently associated with GT placement after adjustment. Early post-procedural oral feeding was independently associated with lower odds of GT placement but may also reflect feeding readiness and clinical recovery.