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Energy metabolism in infants with congenital heart disease
Andreas Nydegger1, Julie E Bines
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia.
Insights
Children with congenital heart disease often experience failure to thrive, impacting recovery after surgery. Nutritional support and optimal surgical timing are crucial for improving growth outcomes in these young patients.
Area of Science:
- Pediatric Cardiology
- Pediatric Surgery
- Nutritional Science
Background:
- Failure to thrive is prevalent in children with congenital heart disease (CHD).
- Energy imbalance significantly contributes to poor nutritional status and impacts outcomes post-cardiac surgery.
- Existing research is limited by small patient cohorts and diverse clinical factors.
Purpose of the Study:
- To analyze the impact of congenital heart disease and corrective surgery on pediatric nutritional status and metabolic response.
- To identify factors influencing nutritional recovery after cardiac surgery.
- To inform optimal timing for corrective surgery and preoperative nutrition support.
Main Methods:
- Review of existing literature on pediatric patients with CHD undergoing corrective surgery.
- Analysis of metabolic responses, energy expenditure, and nutritional status.
- Comparison of outcomes based on patient characteristics and surgical timing.
Main Results:
- Immediate postoperative period shows a hypermetabolic state, followed by low energy expenditure within 24 hours.
- Resting energy expenditure returns to preoperative levels by 5 days post-surgery.
- Significant weight and growth improvements are observed within months, but limited recovery occurs in infants with low birth weight, intellectual deficit, or residual malformations.
Conclusions:
- Nutritional status and growth recovery post-cardiac surgery in children with CHD are influenced by various factors, including preoperative condition and surgical timing.
- Infants with specific risk factors require targeted interventions for better outcomes.
- Further research is needed to optimize nutritional support strategies and surgical timing for maximizing recovery.
Abstract:
Failure to thrive is common in children with congenital heart disease and influences the metabolic response to injury and outcome after corrective cardiac surgery. Energy imbalance is a major contributing factor. However, the published literature is difficult to interpret as studies generally involve small patient numbers with a diverse range of types and severity of cardiac lesions and genetic and/or prenatal factors. The age and time of corrective surgery affects the potential for nutritional recovery. Although the immediate postoperative period is characterized by a hypermetabolic state, low total and resting energy expenditure are reported within 24 h of surgery. After 5 d, resting energy expenditure returns to preoperative levels. Significant improvements in weight and growth occur within months after corrective surgery. However, limited postoperative recovery in nutritional status and growth occurs in infants with a low birth weight, intellectual deficit, or residual malformation. Further studies are needed to inform the timing of corrective cardiac surgery to maximize nutritional outcomes and to identify those infants who may benefit from aggressive preoperative nutrition support.
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CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...