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Overfeeding and obesity in young children with positive pressure ventilation via tracheostomy following cardiac surgery

Published online by Cambridge University Press:  03 August 2020

Takeshi Tsuda Open the ORCID record for Takeshi Tsuda [Opens in a new window] ,
David A. Hehir ,
Deepika Thacker ,
Allison Lamma ,
Donna Tearl  and
Samuel S. Gidding
Takeshi Tsuda*
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
David A. Hehir
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
Deepika Thacker
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
Allison Lamma
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Clinical Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Donna Tearl
Affiliation:
Respiratory Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Samuel S. Gidding
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
*
Author for correspondence: T. Tsuda, MD, FAAP, FACC, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE19803, USA. Tel: +1 (302)651-6677; Fax: +1 (302)651-6601. E-mail: ttsuda@nemours.org
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Abstract

Objectives:

Infants with CHD requiring positive pressure ventilation via tracheostomy are especially vulnerable to malnutrition following cardiac surgery. Current post-operative feeding recommendations may overestimate the caloric needs.

Design:

We retrospectively studied infants requiring tracheostomy after cardiac surgery. Anthropometric and nutritional data were collected, including caloric goals, weight-for-age z score, length-for-age z score, and weight-for-length z score. Changes in anthropometrics over time were compared to ascertain the impact of nutritional interventions. Data were shown as mean ± standard deviation.

Results:

Nineteen infants with CHD required tracheostomy at 160 ± 109 days (7–364 days), 13 had reparative surgery, and 6 had palliative surgery for single ventricle. The indications for tracheostomy consisted of airway abnormality/obstruction (n = 13), chronic respiratory failure (n = 7), and/or vocal cord paresis (n = 2). Initial maintenance nutritional target was set at 100–130 cal/kg per day. Fourteen patients (73.7%) became obese (maximum weight-for-length z score: 2.59 ± 0.47) under tracheostomy and gastrostomy feeding, whereas five patients did not (weight-for-length z score: 0.2 ± 0.83). Eight obese patients (weight-for-length z score: 2.44 ± 0.85) showed effective reduction of obesity within 6 months (weight-for-length z score: 0.10 ± 0.20; p < 0.05 compared with pre-adjustment) after appropriate feeding adjustment (40–90 cal/kg per day). Overall mortality was high (31.6%) in this population.

Conclusion:

Standard nutritional management resulted in overfeeding and obesity in young children with CHD requiring positive pressure ventilation via tracheostomy. Optimal nutritional management in this high-risk population requires close individualised management by multidisciplinary teams.

Keywords

Cardiac surgeryinfantstracheostomyoverfeedingobesitymalnutrition
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1397 - 1404
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med. 2015;16:448–452.CrossRefGoogle ScholarPubMed
Nydegger, A, Bines, JE. Energy metabolism in infants with congenital heart disease. Nutrition. 2006;22:697–704.CrossRefGoogle ScholarPubMed
Ross, F, Latham, G, Joffe, D, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiol Young. 2017;27:1716–1725.CrossRefGoogle ScholarPubMed
Mehta, NM, Bechard, LJ, Cahill, N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study*. Crit Care Med. 2012;40:2204–2211.CrossRefGoogle ScholarPubMed
Mikhailov, TA, Kuhn, EM, Manzi, J, et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr. 2014;38:459–466.CrossRefGoogle ScholarPubMed
Tamayo, C, Manlhiot, C, Patterson, K, Lalani, S, McCrindle, BW. Longitudinal evaluation of the prevalence of overweight/obesity in children with congenital heart disease. Can J Cardiol. 2015;31:117–123.CrossRefGoogle ScholarPubMed
Cohen, MS. Clinical practice: the effect of obesity in children with congenital heart disease. Eur J Pediatr. 2012;171:1145–1150.CrossRefGoogle ScholarPubMed
Mehta, NM. The Goldilocks conundrum for optimal macronutrient delivery in the PICU--too much, too little, or just right? JPEN J Parenter Enteral Nutr. 2013;37:178–180.CrossRefGoogle ScholarPubMed
Skilton, MR, Marks, GB, Ayer, JG, et al. Weight gain in infancy and vascular risk factors in later childhood. Pediatrics. 2013;131:e1821–1828.CrossRefGoogle ScholarPubMed
Chung, ST, Onuzuruike, AU, Magge, SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci. 2018;1411:166–183.CrossRefGoogle ScholarPubMed
LoTempio, MM, Shapiro, NL. Tracheotomy tube placement in children following cardiothoracic surgery: indications and outcomes. Am J Otolaryngol. 2002;23:337–340.CrossRefGoogle ScholarPubMed
Hoskote, A, Cohen, G, Goldman, A, Shekerdemian, L. Tracheostomy in infants and children after cardiothoracic surgery: indications, associated risk factors, and timing. J Thorac Cardiovasc Surg. 2005;130:1086–1093.CrossRefGoogle Scholar
Edwards, JD, Kun, SS, Keens, TG, Khemani, RG, Moromisato, DY. Children with corrected or palliated congenital heart disease on home mechanical ventilation. Pediatr Pulmonol. 2010;45:645–649.CrossRefGoogle ScholarPubMed
Alibrahim, IJ, Kabbani, MS, Abu-Sulaiman, R, Al-Akhfash, A, Mazrou, KA. Outcome of tracheostomy after pediatric cardiac surgery. J Saudi Heart Assoc. 2012;24:163–168.CrossRefGoogle ScholarPubMed
Cotts, T, Hirsch, J, Thorne, M, Gajarski, R. Tracheostomy after pediatric cardiac surgery: frequency, indications, and outcomes. J Thorac Cardiovasc Surg. 2011;141:413–418.CrossRefGoogle ScholarPubMed
Challapudi, G, Natarajan, G, Aggarwal, S. Single-center experience of outcomes of tracheostomy in children with congenital heart disease. Congenit Heart Dis. 2013;8:556–560.CrossRefGoogle ScholarPubMed
Rosner, E, Mastropietro, CW. Prior cardiac surgery is independently associated with decreased survival following infant tracheostomy. Respir Care. 2015;60:47–55.CrossRefGoogle ScholarPubMed
Maxwell, BG, McMillan, KN. Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database. PeerJ. 2014;2:e568.CrossRefGoogle ScholarPubMed
Butnaru, CS, Colreavy, MP, Ayari, S, Froehlich, P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol. 2006;70:115–119.CrossRefGoogle ScholarPubMed
Trachsel, D, Hammer, J. Indications for tracheostomy in children. Paediatr Respir Rev. 2006;7:162–168.CrossRefGoogle ScholarPubMed
Letton, RW, Chwals, WJ, Jamie, A, Charles, B. Early postoperative alterations in infant energy use increase the risk of overfeeding. J Pediatr Surg. 1995;30:988–992; discussion 992–983.CrossRefGoogle ScholarPubMed
Mitchell, IM, Logan, RW, Pollock, JC, Jamieson, MP. Nutritional status of children with congenital heart disease. Br Heart J. 1995;73:277–283.CrossRefGoogle ScholarPubMed
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;81:49–52.CrossRefGoogle ScholarPubMed
Hehir, DA, Rudd, N, Slicker, J, et al. Normal interstage growth after the norwood operation associated with interstage home monitoring. Pediatr Cardiol. 2012;33:1315–1322.CrossRefGoogle ScholarPubMed
Hong, BJ, Moffett, B, Payne, W, Rich, S, Ocampo, EC, Petit, CJ. Impact of postoperative nutrition on weight gain in infants with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2014;147:1319–1325.CrossRefGoogle ScholarPubMed
Li, J, Zhang, G, Herridge, J, et al. Energy expenditure and caloric and protein intake in infants following the Norwood procedure. Pediatr Crit Care Med. 2008;9:55–61.CrossRefGoogle ScholarPubMed
Costello, JP, Emerson, DA, Shu, MK, et al. Outcomes of tracheostomy following congenital heart surgery: a contemporary experience. Congenit Heart Dis. 2015;10:E25–29.CrossRefGoogle ScholarPubMed
Torres, LA, Martinez, FE, Manco, JC. Correlation between standing height, sitting height, and arm span as an index of pulmonary function in 6-10-year-old children. Pediatr Pulmonol. 2003;36:202–208.CrossRefGoogle ScholarPubMed
Mehta, NM, Bechard, LJ, Dolan, M, Ariagno, K, Jiang, H, Duggan, C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011;12:398–405.CrossRefGoogle ScholarPubMed
Cohen, MS, Zak, V, Atz, AM, et al. Anthropometric measures after Fontan procedure: implications for suboptimal functional outcome. Am Heart J. 2010;160:1092–1098, 1098 e1091.CrossRefGoogle ScholarPubMed
Charmandari, E, Kino, T, Souvatzoglou, E, Chrousos, GP. Pediatric stress: hormonal mediators and human development. Horm Res. 2003;59:161–179.Google ScholarPubMed
Krieger, I. Growth failure and congenital heart disease. Energy and nitrogen balance in infants. Am J Dis Child. 1970;120:497–502.CrossRefGoogle ScholarPubMed
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
Jackson, M, Poskitt, EM. The effects of high-energy feeding on energy balance and growth in infants with congenital heart disease and failure to thrive. Br J Nutr. 1991;65:131–143.CrossRefGoogle ScholarPubMed
Unger, R, DeKleermaeker, M, Gidding, SS, Christoffel, KK. Calories count. Improved weight gain with dietary intervention in congenital heart disease. Am J Dis Child. 1992;146:1078–1084.CrossRefGoogle ScholarPubMed
Reid, C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006;19:13–22.CrossRefGoogle ScholarPubMed
Mitchell, IM, Davies, PS, Day, JM, Pollock, JC, Jamieson, MP. Energy expenditure in children with congenital heart disease, before and after cardiac surgery. J Thorac Cardiovasc Surg. 1994;107:374–380.CrossRefGoogle ScholarPubMed
Gebara, BM, Gelmini, M, Sarnaik, A. Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children. Crit Care Med. 1992;20:1550–1554.CrossRefGoogle ScholarPubMed
Siirala, W, Olkkola, KT, Noponen, T, Vuori, A, Aantaa, R. Predictive equations over-estimate the resting energy expenditure in amyotrophic lateral sclerosis patients who are dependent on invasive ventilation support. Nutr Metab (Lond). 2010;7:70.CrossRefGoogle ScholarPubMed
Dokken, M, Rustoen, T, Stubhaug, A. Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed. JPEN J Parenter Enteral Nutr. 2015;39:344–352.CrossRefGoogle ScholarPubMed
Martinez, EE, Smallwood, CD, Bechard, LJ, Graham, RJ, Mehta, NM. Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home. J Pediatr. 2015;166:350–357.CrossRefGoogle ScholarPubMed
Mehta, NM. Energy expenditure: how much does it matter in infant and pediatric chronic disorders? Pediatr Res. 2015;77(1–2):168–172.CrossRefGoogle ScholarPubMed