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

Abstract

Growth failure is often observed in infants with congenital heart disease (CHD); it is unclear, however, whether growth failure is due to increased total energy expenditure (TEE). An observational study of infants with CHD and surgical intervention within the first 30 days of life and healthy infants of similar age was undertaken. TEE was measured using the doubly labeled water method in 3-month-old infants (n = 15 CHD, 12 healthy) and 12-month-old infants (n = 11 CHD, 12 healthy). Multiple linear regression models were fit to examine the association between health status (CHD vs. healthy) and TEE. The accuracy of equations for calculating TEE was also determined. TEE for CHD infants was not significantly different from healthy infants at 3 and 12 months; TEE in CHD infants was 36.4 kcal/day higher (95 % CI -46.3, 119.2; p = 0.37) and 31.7 kcal/day higher, (95 % CI -71.5, 134.8; p = 0.53) at 3 and 12 months, respectively, compared to healthy infants. The 2002 Dietary Reference Intake (DRI) equation and the 1989 Recommended Dietary Allowance equation over-estimated measured TEE to a lesser extent than CHD specific equations; the 2002 DRI yielded the smallest mean difference between calculated versus measured TEE (difference 79 kcal/day). During the first year of life, TEE of infants with CHD and interventional surgery within the first month of life was not different than age-matched healthy infants. When calculating TEE of ≤12-month-old infants with CHD who have undergone surgical intervention, the 2002 DRI equation may be used as a starting point for estimating initial clinical energy intake goals.

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

“…Additionally, a more general goal in cardiologic interventions and surgical procedures is to optimize the energetical state of the heart muscle allowing the most efficient oxygen consumption of the myocardial tissue. This goal can usually be reached by optimization of the hemodynamic situation [3–5]. However, in patients with CoA, even years after successful treatment of the narrowing, increased morbidity and mortality have remained major issues.…”

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

“…Fortunately, with improved surgical and catheter‐based interventions, intensive care, imaging, medical therapies, and specialty teams trained to manage HF in children, survival rates have improved . Care has shifted from focusing on survival to optimizing quality of life and health outcomes, such as nutrition status . Appropriate growth in well children is considered an important indicator of health.…”

“…1 Care has shifted from focusing on survival to optimizing quality of life and health outcomes, such as nutrition status. 5 Appropriate growth in well children is considered an important indicator of health. In the context of HF, appropriate growth may indicate control of HF symptoms.…”

A Comparative Analysis of Equations to Estimate Patient Energy Requirements Following Cardiopulmonary Bypass for Correction of Congenital Heart Disease

“…Due to this complex milieu, there is no consensus on the ideal equation for estimating REE in pediatric patients following CPB. Existing studies have shown poor performance of these estimates overall …”

“…Existing studies have shown poor performance of these estimates overall. 12 In this study, the utility of a novel method of estimating REE is assessed compared with gold standard indirect calorimetry in a cohort of critically ill children following CPB. An additional objective of this study was to perform a comparative analysis of the accuracy of this novel methodology relative to other currently used clinical equations with reference to indirect calorimetry measurement.…”