Changes in resting energy expenditure in children with congenital heart disease

Abstract

Objectives: The aim of this study was to relate changes in energy expenditure and growth in infants with congenital heart disease (CHD), to the timing of corrective cardiac surgery. Methods: Prospective cohort study of infants less than 1 year with CHD admitted for cardiac surgery to Royal Children's Hospital, between January to September 2005. Infants were assessed using anthropometry and indirect calorimetry and compared to healthy age-matched controls. Results: Infants (38) underwent corrective (n ¼ 25) or palliative (n ¼ 13) cardiac surgery either at p10 days or at 410 days. Infants undergoing corrective surgery after 10 days had deficits in z-scores for weight compared with infants undergoing early surgery (À1.15 ± 1.02 vs À0.24 ± 0.98; CI 95%: À1.736 to À0.085; Po0.05) and height (À1.47 ± 1.16 vs À0.12 ± 0.66; CI 95%: À2.262 to À0.428; Po0.01). However, 6 months following surgery, weight and height were similar in both groups. Resting energy expenditure was increased before surgery compared to healthy controls (247 ± 36 vs 210 ± 22 kJ kg À1 day À1 ; 95% CI: À57.29 to À16.71; Po0.001) however, normalized 1 week following cardiac surgery. Standard equations did not accurately predict measured REE. Conclusion: Increased REE observed in infants with CHD normalizes within 1 week following corrective cardiac surgery. Deficits in weight and growth were greater in infants undergoing corrective cardiac surgery410 days of age compared with infants undergoing surgery in the first 10 days of life.

Optimizing Nutrition in Pediatric Heart Failure: The Crisis Is Over and Now It’s Time to Feed

“…Indirect calorimetry can be used as an assessment tool to help determine requirements during different stages of illness and congestive HF . It is the preferred method for estimating a critically ill child’s resting energy expenditure, as predictive equations may overestimate or underestimate needs . Although not usually clinically feasible, mass spectrometry is another potentially desirable method for estimation of energy expenditure and respiratory quotient .…”

Is Energy Expenditure of Infants Predictable After Surgery?

“…17 Another study investigating changes in energy expenditure with congenital heart disease found a significant decrease in MEE 1 week after corrective or palliative cardiac repair compared with preoperative measures, although the selection of these subjects was significantly biased based on respiratory status and timing of dietitian referral. 18 Numerous confounding factors contribute to inconsistent findings in reported data, including age, developmental or growth stage, body composition, underlying or preexisting illness, study design, and technical limitations.…”

“…Mean MEE was significantly higher 19 than the mean REE predicted by the WHO 21 equation. Children with congenital heart disease may indeed have a higher energy expenditure than their peers, particularly prior to surgical repair, 18 but study methods and findings have been inconsistent. 5,18,19 For this cohort, the authors concluded that the Schofield equation was more accurate than the WHO; however, MEE is preferred to estimation of REE.…”

Nutrition Support of the Postoperative Cardiac Surgery Child

“…A study was conducted in 38 cardiac surgery patients and 23 healthy control infants (mean: 16 d, range: 0‐352 d) assessing the impact of early surgical correction of congenital heart disease on nutrition and growth outcomes. The researchers found that at 1 week postoperatively, the resting energy expenditure of the cardiac surgery pediatric patients had normalized from a hypermetabolic response to a normometabolic response of 49 ± 9 kcal/kg/d in comparison to the healthy control group 18 . Furthermore, it has been shown that 8 days postoperatively, the metabolic response seems to resolve to a near‐anabolic state in pediatric patients 19 …”