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Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge

  • Barbara Medoff-Cooper (a1), Sharon Y. Irving (a2), Bradley S. Marino (a3), J. Felipe García-España (a4), Chitra Ravishankar (a5), Geoffrey L. Bird (a6) and Virginia A. Stallings (a4)...

Abstract

Objective

The purpose of this study was to assess the pattern of weight change from surgical intervention to home discharge and to determine predictors of poor growth in this population of infants with congenital cardiac disease.

Methods

Neonates with functionally univentricular physiology enrolled in a prospective cohort study examining growth between March, 2003 and May, 2007 were included. Weights were collected at birth, before surgical intervention, and at hospital discharge. In addition, retrospective echocardiographic data and data about post-operative complications were reviewed. Primary outcome variables were weight-for-age z-score at discharge and change in weight-for-age z-score between surgery and discharge.

Results

A total of 61 infants met the inclusion criteria. The mean change in weight-for-age z-score between surgery and hospital discharge was minus 1.5 plus or minus 0.8. Bivariate analysis revealed a significant difference in weight-for-age z-score between infants who were discharged on oral feeds, minus 1.1 plus or minus 0.8 compared to infants with feeding device support minus 1.7 plus or minus 0.7, p-value equal to 0.01. Lower weight-for-age z-score at birth, presence of moderate or greater atrioventricular valve regurgitation, post-operative ventilation time, and placement of an additional central venous line were associated with 60% of the variance in weight-for-age z-score change.

Conclusion

Neonates undergoing staged surgical repair for univentricular physiology are at significant risk for growth failure between surgery and hospital discharge. Haemodynamically significant atrioventricular valve regurgitation and a complex post-operative course were risk factors for poor post-operative weight gain. Feeding device support appears to be insufficient to ensure adequate weight gain during post-operative hospitalisation.

Copyright

Corresponding author

Correspondence to: B. Medoff-Cooper, RN, PhD, FAAN, Ruth M. Colket Professor in Pediatric Nursing, The Children’s Hospital of Philadelphia, Professor, University of Pennsylvania, School of Nursing, 418 Curie Boulevard, Claire M. Fagin Hall, Philadelphia, Pennsylvania 19104, United States of America. Tel: 215 898 3399; Fax: 215 898 3056; E-mail: medoff@nursing.upenn.edu

References

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1. Varan, B, Tokel, K, Yilmaz, G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 1999; 81: 4952.
2. Fleisher, BE, Baum, D, Brudos, G, et al. Infant heart transplantation at Stanford: growth and neurodevelopmental outcome. Pediatrics 2002; 109: 17.
3. De Staebel, O. Malnutrition in Belgian children with congenital heart disease on admission to hospital. J Clin Nurs 2000; 9: 784791.
4. Cohen, MI, Bush, DM, Ferry, RJ Jr, et al. Somatic growth failure after the Fontan operation. Cardiol Young 2000; 10: 447457.
5. Cameron, JW, Rosenthal, A, Olson, AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med 1995; 149: 10981102.
6. 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: 5257.
7. 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: 328333.
8. Einarson, KD, Arthur, HM. Predictors of oral feeding difficulty in cardiac surgical infants. Pediatr Nurs 2003; 29: 315319.
9. Boctor, D, Pillo-Blocka, F, McCrindle, BW. Nutrition after cardiac surgery for infants with congenital heart disease. Nutr Clin Pract 1999; 14: 111115.
10. Imms, C. Feeding the infant with congenital heart disease: an occupational performance challenge. Am J Occup Ther 2001; 55: 277284.
11. Pillo-Blocka, F, Adatia, I, Sharieff, W, McCrindle, BW, Zlotkin, S. Rapid advancement to more concentrated formula in infants after surgery for congenital heart disease reduces duration of hospital stay: a randomized clinical trial. J Pediatr 2004; 145: 761766.
12. 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: 237244.
13. Steltzer, M, Rudd, N, Pick, B. Nutrition care for newborns with congenital heart disease. Clin Perinatol 2005; 32: 10171030.
14. Skinner, ML, Halstead, LA, Rubinstein, CS, Atz, AM, Andrews, D, Bradley, SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 12931301.
15. 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: 5969.
16. 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: 6370.
17. Bhoomika, K, Shobini, R, Chandramouli, B. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct 2008; 4: 112.
18. Argyle, J. Approaches to detecting growth faltering in infancy and childhood. Ann Hum Biol 2003; 30: 499519.
19. Braudis, NJ, Curley, MA, Beaupre, K, et al. Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med 2009; 10: 460466.
20. 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: 283289.
21. 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: 495501.
22. McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 10801087.
23. Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180184.
24. Lacour-Gayet, F, Clarke, DR. The Aristotle method: a new concept to evaluate quality of care based on complexity. Curr Opin Pediatr 2005; 17: 412417.
25. Derby, CD, Kolcz, J, Kerins, PJ, Duncan, DR, Quezada, E, Pizarro, C. Aristotle score predicts outcome in patients requiring extracorporeal circulatory support following repair of congenital heart disease. ASAIO J 2007; 53: 8286.
26. Oken, E, Kleinman, KP, Rich-Edwards, J, Gillman, MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. Pediatrics 2003; 3: 6.
27. Menon, G, Poskitt, EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child 1985; 60: 11341139.
28. Vogt, KN, Manlhiot, C, Van Arsdell, G, Russell, JL, Mital, S, McCrindle, BW. Somatic growth in children with single ventricle physiology impact of physiologic state. J Am Coll Cardiol 2007; 50: 18761883.
29. Behrman, RE. Overview of pediatrics. In: Behrman RE, Kliegman RM, Jenson HB (eds.). Nelson Textbook of Pediatrics. Saunders, Philadelphia, 2004; 144.
30. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.
31. Jadcherla, S, Vijayapal, A, Leuthner, S. Feeding abilities in neonates with congenital heart disease: a retrospective study. Journal of Perinatology 2009; 29: 112118.
32. Kogon, B, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2007; 2: 332337.

Keywords

Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge

  • Barbara Medoff-Cooper (a1), Sharon Y. Irving (a2), Bradley S. Marino (a3), J. Felipe García-España (a4), Chitra Ravishankar (a5), Geoffrey L. Bird (a6) and Virginia A. Stallings (a4)...

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