Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T02:57:44.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Poor post-operative growth in infants with two-ventricle physiology

Published online by Cambridge University Press:  09 March 2011

Jeffrey B. Anderson ,
Bradley S. Marino ,
Sharon Y. Irving ,
J. Felipe García-España ,
Chitra Ravishankar ,
Virginia A. Stallings  and
Barbara Medoff-Cooper
Jeffrey B. Anderson*
Affiliation:
Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Bradley S. Marino
Affiliation:
Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Sharon Y. Irving
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
J. Felipe García-España
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Chitra Ravishankar
Affiliation:
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Virginia A. Stallings
Affiliation:
Division of Gastroenterology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Barbara Medoff-Cooper
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: J. B. Anderson, MD, MPH, Division of Cardiology, Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2003, Cincinnati, 45255 Ohio, United States of America. Tel: 513 636 3865; Fax: 513 636 3952; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Adequate nutritional support is essential for normal infant growth and development. Infants with congenital cardiac disease are known to be at risk for growth failure. We sought to describe perioperative growth in infants undergoing surgical repair of two-ventricle congenital cardiac disease and assess for predictors of their pattern of growth.

Materials and methods

Full-term infants who underwent surgical repair of two-ventricle congenital cardiac disease at a single institution were enrolled in a retrospective cohort study performed following a larger prospective study. Infants with facial, gastrointestinal, or neurologic anomalies, trisomy chromosomal abnormality, birth weight less than 2500 grams, or those transferred to another institution before discharge home were excluded. The primary outcome was change in weight-for-age z score from surgery to discharge. Our secondary outcome variable was post-operative hospital length of stay.

Results

A total of 76 infants met the inclusion criteria. Medain age at surgery was 5 days with a range from 1 to 44. The median weight-for-age z score at surgery was −0.2 with a range from −2.9 to 2.8 and by discharge had dropped to −1.2 with a range from −3.4 to 1.8. The median change in weight-for-age z score from surgery to discharge was −1.0 with a range from −2.3 to 0.2. Delayed post-operative nutrition (p < 0.001) and reintubation following initial post-operative extubation (p = 0.001) were associated with decrease in weight-for-age z score.

Conclusions

Infants undergoing repair of two-ventricle congenital cardiac disease had poor growth in the post-operative period. This may be mitigated by early initiation of post-operative nutrition.

Keywords

Congenital cardiac diseaseinfant weightnutritional status
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 4 , 12 July 2011 , pp. 421 - 429
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Argyle, J. Approaches to detecting growth faltering in infancy and childhood. Ann Hum Biol 2003; 30: 499–519.CrossRefGoogle ScholarPubMed
2.Rudolf, MC, Logan, S. What is the long term outcome for children who fail to thrive? A systematic review. Arch Dis Child 2005; 90: 925–931.CrossRefGoogle Scholar
3.Grantham-McGregor, SM, Walker, SP, Chang, S. Nutritional deficiencies and later behavioural development. Proc Nutr Soc 2000; 59: 47–54.CrossRefGoogle ScholarPubMed
4.Black, MM, Dubowitz, H, Krishnakumar, A, Starr, RH Jr. Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics 2007; 120: 59–69.CrossRefGoogle ScholarPubMed
5.Dykman, RA, Casey, PH, Ackerman, PT, McPherson, WB. Behavioral and cognitive status in school-aged children with a history of failure to thrive during early childhood. Clin Pediatr (Phila) 2001; 40: 63–70.CrossRefGoogle ScholarPubMed
6.Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
7.Forchielli, ML, McColl, R, Walker, WA, Lo, C. Children with congenital heart disease: a nutrition challenge. Nutr Rev 1994; 52: 348–353.CrossRefGoogle ScholarPubMed
8.Menon, G, Poskitt, EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child 1985; 60: 1134–1139.CrossRefGoogle ScholarPubMed
9.Vaisman, N, Leigh, T, Voet, H, Westerterp, K, Abraham, M, Duchan, R. Malabsorption in infants with congenital heart disease under diuretic treatment. Pediatr Res 1994; 36: 545–549.CrossRefGoogle ScholarPubMed
10.Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-Transposition of the great arteries. Pediatr Cardiol 2007; 29: 328–333.CrossRefGoogle ScholarPubMed
11.Lees, MH, Bristow, JD, Griswold, HE, Olmsted, RW. Relative hypermetabolism in infants with congenital heart disease and undernutrition. Pediatrics 1965; 36: 183–191.CrossRefGoogle ScholarPubMed
12.Vaidyanathan, B, Roth, SJ, Gauvreau, K, Shivaprakasha, K, Rao, SG, Kumar, RK. Somatic growth after ventricular septal defect in malnourished infants. J Pediatr 2006; 149: 205–209.CrossRefGoogle ScholarPubMed
13.Mahle, WT, Spray, TL, Wernovsky, G, Gaynor, JW, Clark, BJ 3rd. Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15-year experience from a single institution. Circulation 2000; 102: III136–III141.CrossRefGoogle ScholarPubMed
14.Wright, C, Parkinson, K. Postnatal weight loss in term infants: what is “normal” and do growth charts allow for it? Arch Dis Child 2004; 89: 254–257.CrossRefGoogle Scholar
15.Cribbs, RK, Heiss, KF, Clabby, ML, Wulkan, ML. Gastric fundoplication is effective in promoting weight gain in children with severe congenital heart defects. J Pediatr Surg 2008; 43: 283–289.CrossRefGoogle ScholarPubMed
16.Davis, D, Davis, S, Cotman, K, et al. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29: 328–333.CrossRefGoogle ScholarPubMed
17.Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495–501.CrossRefGoogle ScholarPubMed
18.Schwalbe-Terilli, CR, Hartman, DH, Nagle, ML, et al. Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 2009; 18: 52–57.CrossRefGoogle ScholarPubMed
19.Lacour-Gayet, F, Clarke, DR. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr 2005; 17: 412–417.CrossRefGoogle Scholar
20.Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–184.CrossRefGoogle ScholarPubMed
21.World Health Organization. WHO Child Growth Standards, Length/height-for-age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index for Age: Methods and Development. World Health Organization, France, 2006.Google Scholar
22.Kelleher, DK, Laussen, P, Teixeira-Pinto, A, Duggan, C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237–244.CrossRefGoogle ScholarPubMed
23.Anderson, JB, Beekman, RH 3rd, Eghtesady, P, et al. Predictors of poor weight gain in infants with a single ventricle. J Pediatr 2010; 157: 407–413.CrossRefGoogle ScholarPubMed
24.Agus, MS, Jaksic, T. Nutritional support of the critically ill child. Curr Opin Pediatr 2002; 14: 470–481.CrossRefGoogle ScholarPubMed
25.Shulman, RJ, Phillips, S. Parenteral nutrition in infants and children. J Pediatr Gastroenterol Nutr 2003; 36: 587–607.Google ScholarPubMed
26.Owens, JL, Musa, N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract 2009; 24: 242–249.CrossRefGoogle ScholarPubMed
27.Madhok, AB, Ojamaa, K, Haridas, V, Parnell, VA, Pahwa, S, Chowdhury, D. Cytokine response in children undergoing surgery for congenital heart disease. Pediatr Cardiol 2006; 27: 408–413.CrossRefGoogle ScholarPubMed
28.Cooper, DS, Nichter, MA. Advances in cardiac intensive care. Curr Opin Pediatr 2006; 18: 503–511.CrossRefGoogle ScholarPubMed
29.Meyer, R, Harrison, S, Sargent, S, Ramnarayan, P, Habibi, P, Labadarios, D. The impact of enteral feeding protocols on nutritional support in critically ill children. J Hum Nutr Diet 2009; 22: 428–436.CrossRefGoogle ScholarPubMed
30.Kogon, BE, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2007; 2: 332–337.CrossRefGoogle ScholarPubMed
31.Boethig, D, Jenkins, KJ, Hecker, H, Thies, WR, Breymann, T. The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population. Eur J Cardiothorac Surg 2004; 26: 12–17.CrossRefGoogle Scholar
32.Larsen, SH, Pedersen, J, Jacobsen, J, Johnsen, SP, Hansen, OK, Hjortdal, V. The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease. Eur J Cardiothorac Surg 2005; 28: 877–881.CrossRefGoogle Scholar