Nutrition of neonates with congenital heart disease: existing evidence, conflicts and concerns

Tsintoni, Asimina; Dimitriou, Gabriel; Karatza, Ageliki

doi:10.1080/14767058.2018.1548602

Cited by 35 publications

(30 citation statements)

References 38 publications

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“…Similar association between malnutrition in CHD and prolonged postoperative ICU stay was found by Silva et al and Ross et al 28,29 Continuous assessment of nutritional status for patients with CHD, proper counselling from early stages of life and implementation of treatment strategies that aim to facilitate "catch-up" can improve operative and postoperative outcomes. [30][31][32]…”

Section: Discussionmentioning

confidence: 99%

Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

Khasawneh¹,

Mohammad

Alfawares³

et al. 2021

Int J Adv Med

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Background: To identify the prevalence, predictors and implications of malnutrition and failure to thrive (FTT) in paediatric cardiac surgical patients.Methods: Observational retrospective analysis of data of paediatric patients presenting for cardiac surgery at Queen Alia heart institute/Amman/Jordan between April 2020 and October 2020. Patients' ages, anthropometric measurements, diagnoses, type of surgical intervention, ICU stay and perioperative outcomes were recorded on a special form designed for the purpose of this study. Prevalence of malnutrition based on world health organization (WHO) and centers for disease control (CDC) growth charts was determined using height-for-age z-score (HAZ) and percentile, weight-for-age z-score (WAZ) and percentile, weight-for-height z-score (WHZ) and percentile. BMI was used for patients above 2 years of age in 109 paediatric cardiac surgical patients. Prevalence of malnutrition and FTT was examined according to age category and cardiac pathology). Patients were divided according to heart pathology into cyanotic and acyanotic CHD.Results: One hundred and nine pediatric cardiac surgical patients were presented for cardiac surgery (59 males and 50 females). Patients' age ranged from 2 days to 17 years (mean 3.7 years, SD±4.5 years). Patients' body weight ranged from 2.7 to 70 kg (mean 14.98 kg, SD±14.2 kg). Average weight percentile was 19.26 (SD±20.01) and ranged between 0.1 and 88.5 and the average Z-score for weight was -1.274±1.037 (mean±SD). The overall height percentile for the all patients with CHD averaged 18.53±17.1 (mean±SD) and the average Z-score for height was -1.1029±0.743 (mean±SD). Prevalence of isolated malnutrition and FTT was 33.2% and 20.2%. Normal nutritional status was found in 46.78%. Cyanotic type CHD was more commonly associated with FTT (p=0.001), longer cardiopulmonary bypass (p=0.001), higher intraoperative lactate (p=0.012) and aortic cross clamp times (p=0.001). Patients with malnutrition and FTT had average ICU stay of 4.32±2.219 days and averaged 4.772±2.065 days (mean±SD) respectively, which was almost double of the ICU stay of patients who had normal nutritional status 2.32±2.261 days (mean±SD).Conclusions: Prevalence of malnutrition and FTT is high in paediatric patients with CHD at time of presentation for surgery. Predicting factors for malnutrition and FTT are cyanotic type of CHD and smaller age. Malnutrition was associated with longer ICU stay.

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Section: Discussionmentioning

confidence: 99%

Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

Khasawneh¹,

Mohammad

Alfawares³

et al. 2021

Int J Adv Med

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“…Yanagisawa et al used ultrasound to evaluate for skin edema in pregnant women and was able to manually measure the depth of subcutaneous edema (26). A study by Eisenbeiss et al demonstrated that subcutaneous tissue thickness increased following fluid infusion and can be measured by ultrasound in healthy adult volunteers (35). Our study is the first to apply this ultrasound tool of measuring fluid overload to neonates and infants with CHD.…”

Section: Discussionmentioning

confidence: 80%

“…More surprisingly, we did not identify consistent differences between neonates with CHD at baseline and healthy neonatal controls. We expected to find increased subcutaneous tissue in the healthy neonates as it is well-established that infants with CHD frequently struggle to achieve adequate somatic growth ( 36 , 37 ). In fact, the only statistically significant difference that we did find was that neonates with CHD had a minimally increased subcutaneous tissue thickness, on the degree of 1 mm, in the lateral chest compared to controls, and this difference was not reproduced in any other body site.…”

Section: Discussionmentioning

confidence: 99%

“…Skin ultrasound is performed in both adult and pediatric emergency departments to diagnose skin and soft tissue infections, which can include qualitatively recognizing edema (32)(33)(34). However, the quantification of extravascular fluid overload via ultrasound has rarely been studied in adults and never previously attempted in infants with CHD (26,35). Yanagisawa et al used ultrasound to evaluate for skin edema in pregnant women and was able to manually measure the depth of subcutaneous edema (26).…”

Section: Discussionmentioning

confidence: 99%

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Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

et al. 2021

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Purpose: Fluid overload is a common post-operative issue in children following cardiac surgery and is associated with increased morbidity and mortality. There is currently no gold standard for evaluating fluid status. We sought to validate the use of point-of-care ultrasound to measure skin edema in infants and assess the intra- and inter-user variability.Methods: Prospective cohort study of neonates (≤30 d/o) and infants (31 d/o to 12 m/o) undergoing cardiac surgery and neonatal controls. Skin ultrasound was performed on four body sites at baseline and daily post-operatively through post-operative day (POD) 3. Subcutaneous tissue depth was manually measured. Intra- and inter-user variability was assessed using intraclass correlation coefficient (ICC).Results: Fifty control and 22 surgical subjects underwent skin ultrasound. There was no difference between baseline surgical and control neonates. Subcutaneous tissue increased in neonates starting POD 1 with minimal improvement by POD 3. In infants, this pattern was less pronounced with near resolution by POD 3. Intra-user variability was excellent (ICC 0.95). Inter-user variability was very good (ICC 0.82).Conclusion: Point-of-care skin ultrasound is a reproducible and reliable method to measure subcutaneous tissue in infants with and without congenital heart disease. Acute increases in subcutaneous tissue suggests development of skin edema, consistent with extravascular fluid overload. There is evidence of skin edema starting POD 1 in all subjects with no substantial improvement by POD 3 in neonates. Point-of-care ultrasound could be an objective way to measure extravascular fluid overload in infants. Further research is needed to determine how extravascular fluid overload correlates to clinical outcomes.

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“…Faltering Growth (5). Although the cause of growth failure is multifactorial in these infants, it is fundamentally related to increased energy expenditure and inadequate caloric intake for growth (6)(7)(8). Because of this hyper metabolic state (9), their need for energy may be 20 to-50% higher compared to that of healthy children, to obtain normal growth and development (3,(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Nutritional support with energy and nutrient-dense formula for children with congenital heart defects: A clinical trial

Moghadam¹,

Mirzaaghayan²,

Goedhart³

et al. 2020

Preprint

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Background: A large proportion of infants with congenital heart defects (CHD) suffer from malnutrition. The aim of this study was to assess the impact of using energy- and nutrient-dense formula on weight gain in malnourished infants with CHD before surgery. Methods: This was a one arm, open label intervention study, conducted in the pediatric cardiology department of children’s medical center, Teheran, Iran. 49 infants with moderate/high risk cardiac defects who were undernourished (WFA z-score ≤ - 2) and were candidates for surgical repair were enrolled in this study. Infants on regular infant formula were switched completely to energy- and nutrient-dense formula. The infants were evaluated for growth parameters (weight and length) at enrolment and every 3 weeks thereafter at the center for a period of 12 weeks. Results: The average head circumference was 37.1+2.8 cm at baseline and 39.0+3.46 cm at the final assessment (p=0.079). The mean MUAC increased from 11.25+1.39 cm at baseline to 14.75+2.06 cm at the final assessment (p=0.001). The average intake of energy- and nutrient-dense formula was 148.24+214.737 Kcal/day (36.23+ 52.49 Kcal/kg/day) at study start and 455.4+177.21 Kcal/day (98.61 ± 38.27 Kcal/kg/day) at the end of the study. The WFA z-score improved significantly on each visit during the follow-up interval (p<0.0001). Conclusion: The results of the current study highlight the efficacy of preoperative feeding with energy- and nutrient dense formula in improving weight gain of malnourished infants with CHD.reference number: IR.TUMS.VCR.REC.1396.3543

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Nutrition of neonates with congenital heart disease: existing evidence, conflicts and concerns

Cited by 35 publications

References 38 publications

Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

Validation of Point-of-Care Ultrasound to Measure Perioperative Edema in Infants With Congenital Heart Disease

Nutritional support with energy and nutrient-dense formula for children with congenital heart defects: A clinical trial

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