Nutrition After Cardiac Surgery for Infants With Congenital Heart Disease

Abstract

Inadequate nutrition support in the postoperative period in infants recovering from cardiac surgery can impact morbidity and growth. We sought t o determine postoperative nutrition support patterns and identify factors associated with rate of weight gain in infants <1 year. Data were collected from the medical records of 24 infants. The median age a t surgery was 2.7 months (range, 1 day to 9 months). The median overall daily weight change during the postoperative ward stay was -11 gld (range, -145 to +84 gld), with a net positive gain in 8 (36101, net loss in 14 (64%) and unknown in 2 infants. The rate of weight change by hospital discharge was related to feeding practice: bottle fed infants gained a median of 20 gld (range, -100 to +73 gld); breast fed infants who were supplemented with bottle feeds gained a median of 5 gld (range, -83 to +43 gld); and exclusively breast fed infants lost a median of 49 gld (range, -80 to -23 gld)(p = .04). Patients who were meeting a greater percentage of their energy requirements by the time of hospital discharge had higher rates of weight gain ( r = .78; p = .003). Rate of weight gain was not related to cardiac lesion or hospital length of stay. We conclude that weight gain after cardiac surgery in infants is sub-optimal and is related t o feeding practices. Greater attention to achieving energy requirements during postoperative recovery is necessary, especially in breast fed infants.In the last 30 years failure to thrive has been a concern in infants and children with congenital heart disease.' Although there is no uniform Correspondence and reprint requests: Brian RIcCrindle, RID, RIPH,

Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: A randomized clinical trial

“…4 The second study examined a less complex group of patients admitted electively for corrective cardiac surgery. 5 Findings from the two studies were similar. The rate of weight gain of many infants deteriorated after cardiac surgery, and in-hospital feeding regimens frequently did not provide sufficient energy intake by the time of discharge from hospital.…”

“…Although the underlying cause of nutritional problems in these patients is variable, there is increasing evidence that an important contributing factor is inadequate energy intake for prolonged periods of time. [4][5][6][7] It has been well documented that feeding problems may include incoordination of sucking, swallowing, and breathing, an inefficient, weak suck, emesis, and effortless vomiting. Inadequate energy and nutrient intake caused by poor feeding may affect recovery from surgery and increase morbidity during this critical period (Figure).…”

“…4,5 The first study examined a homogeneous group of infants who had undergone palliative surgery (stage 1 Norwood procedure) for hypoplastic left heart syndrome. 4 The second study examined a less complex group of patients admitted electively for corrective cardiac surgery.…”

Total Energy Expenditure of Infants with Congenital Heart Disease Who Have Undergone Surgical Intervention

“…Infants with CHD are at greater risk of neurodevelopmental delay [24,36,37], and poor growth has been shown to negatively affect developmental outcomes and length of hospital stay [3,17]. Persistent congestive heart failure [10,23,49], neurologic injury [31,32,34], genetic abnormalities [6], gastrointestinal malabsorption [22,23,35], vocal cord and swallowing dysfunction [13,27], gastroesophageal reflux disease [10], and oral aversion [26] are common in infants with CHD and may contribute to insufficient energy intake [5,8] and subsequently poor growth.…”

Nutrition in Congenital Heart Disease: Challenges, Guidelines and Nutritional Support

“…With close monitoring, nutrition interventions -via oral intake or nutrition support -may be well tolerated and can promote weight gain [11,12]. Malnutrition in infants and children with CHD should be prevented rather than expected.…”