Anthropometric growth and utilization of enteral feeding support in pediatric heart transplant recipients

Abstract

We sought to outline trends in anthropometric growth before and after cardiac transplantation and to document our experience with the use of EFS in this population. A total of 130 patients (59% male) were enrolled and followed for a median of 4.4 yr after transplantation. Negative changes over time in weight z-score (EST: -0.256 [0.160] z/yr, p = 0.01), height z-score (EST: -0.214 [0.096] z/yr, p = 0.03), and BMI z-score (EST: -0.287 [0.161] z/yr, p = 0.07) were observed prior to transplantation. Significant increases in weight z-score (EST: +0.342 [0.143] z/yr, p < 0.001) and BMI z-score (EST: +0.396 [0.140] z/yr, p = 0.005) were seen in the first 18 months following transplantation. No further increases in height, weight, or BMI z-score were seen beyond this. Forty-two (32%) patients received EFS. Prior to transplantation, it was not found to be associated with change in anthropomorphic growth. Post-transplantation exposure to EFS was associated with a faster increase in weight z-score (EST: +0.480 [0.231] z/yr, p = 0.04) and height z-score over time (EST: +0.366 [0.141] z/yr, p = 0.01). Normalization of weight and height z-scores was not achieved during the study follow-up period. This study suggests that further investigation into the role of EFS is warranted to identify strategies to improve growth in pediatric heart transplant recipients.

The role of serum albumin in the prediction of malnutrition in patients at least five yr after heart transplantation

“…According to Eurotransplant data 553, HTXs have been performed in total in 2009 inside the Eurotransplant countries . Malnutrition and its consequences for the long‐term survival and outcome after HTX are already recognized as major risk factors for pediatric as well as for adult patients . As patients after cardiac transplantation have to be administered more intensive immunosuppression as compared to patients after other solid organ transplantation, they are at higher risk for diseases triggered by immunosuppression as well .…”

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

“…Historically, with medical management of HF, nutritional rehabilitation has been difficult to achieve in children awaiting HT, even when enteral feeds, caloric supplementation, or TPN are used . Studies have shown that malnutrition occurs commonly in children listed for HT and often worsens through the waitlist period .…”

Nutrition Management After Pediatric Solid Organ Transplantation

“…The authors reported that 17% of the population became overweight by 2 years posttransplant and noted that increases in weight without corresponding height may result in obesity. In a more recent study of 130 pediatric heart transplant recipients, Bannister et al 39 reported that enteral feeding support during the posttransplant period significantly improved rates of weight and height gain. However, anthropometric measures did not reach normal values during the study follow‐up period (median 4.4 years after transplantation).…”

“…Children with coronary heart disease or cardiomyopathy with end‐stage heart failure are at risk for failure to thrive due to multiple hospitalizations for surgical procedures, 39 feeding intolerance and malabsorption, 60 and possibly increased energy requirements 61 . The effect of undernutrition on adverse outcomes is unclear.…”

“…In a cohort of 130 pediatric heart transplant recipients (median age at transplant = 2.7 years), Bannister et al 39 reported that the use of enteral feeding support prior to pediatric heart transplant was not associated with anthropometric growth. Although posttransplant enteral feeding support was associated with a faster increase in weight and height z scores over the 4‐year follow‐up period, values plateaued at 18 months posttransplant and the measures did not reach normative values.…”