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Enteral nutrition in infants with congenital heart disease and growth failure
S M Schwarz1, M H Gewitz, C C See
1Department of Pediatrics, New York Medical College, Valhalla 10595.
Insights
Continuous 24-hour nasogastric feeding is effective for infants with congenital heart disease and growth failure. This method significantly improves nutritional status and nutrient intake in these vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Nutrition
- Growth and Development
Background:
- Infants with congenital heart disease (CHD) and congestive heart failure (CHF) often experience growth failure.
- Malnutrition in these infants can exacerbate cardiac conditions and complicate recovery.
- Effective nutritional management is crucial for improving outcomes in infants with CHD and CHF.
Purpose of the Study:
- To evaluate the efficacy of different nutritional regimens for managing growth failure in infants with CHD and CHF.
- To determine the optimal method for achieving adequate nutrient intake and improving nutritional status in this patient population.
Main Methods:
- A randomized study involving 19 infants with cardiac anomalies not eligible for early surgery.
- Three feeding groups were established: continuous 24-hour nasogastric (NG) feeding, 12-hour overnight NG feeding with daytime oral intake, and oral feeding alone.
- Infant formula was supplemented to achieve a calorie density of approximately 1 kcal/mL for all groups.
Main Results:
- Only infants receiving continuous 24-hour NG alimentation achieved nutrient intakes exceeding 140 kcal/kg/day.
- Continuous 24-hour NG feeding was associated with significant improvements in weight (z scores, P < .01) and length (z scores, P < .05).
- Marked increases in midarm muscle circumference and skinfold thicknesses were observed in the continuous feeding group (P < .01).
Conclusions:
- Infants with CHD and malnutrition have increased nutrient requirements for optimal growth.
- Continuous, 24-hour nasogastric alimentation is a safe and effective strategy for enhancing nutrient intake.
- This feeding method significantly improves overall nutritional status in infants with congenital cardiac defects and growth failure.
Abstract:
To determine an effective nutritional regimen for management of growth failure in infants with congenital heart disease and congestive heart failure, the authors studied 19 infants with cardiac anomalies who were not candidates for early corrective surgery. Patients were randomly assigned to one of three feeding groups: group 1 (n = 7) received continuous, 24-hour nasogastric alimentation; group 2 (n = 5) received overnight, 12-hour nasogastric infusions plus daytime oral feedings as tolerated; and group 3 (n = 7) received oral feedings alone. For all patients, commercial infant formula (cow's milk or soy protein) was supplemented to a calorie density of approximately 1 kcal/mL. During a 5.25 +/- 0.45 month study period, only group 1 infants achieved intakes greater than 140 kcal/kg per day (mean = 147 kcal). Serial anthropometric measurements demonstrated that only 24-hour infusions (group 1) were associated with significantly improved nutritional status, when assessed by z scores for weight (P less than .01) and length (P less than .05). Group 1 infants also showed marked increases in midarm muscle circumference and triceps and subscapular skinfold thicknesses (P less than .01, compared with groups 2 and 3). These data suggest that infants with congenital cardiac defects complicated by malnutrition manifest increased nutrient requirements for growth and weight gain. Continuous, 24-hour, nasogastric alimentation is a safe and effective method for achieving both increased nutrient intake and improved overall nutritional status in these infants.