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Published on: June 29, 2013
Growth and Nutritional Intake of Infants with Univentricular Circulation
Anne Marie Shine1, Leah Foyle1, Emma Gentles1
1Department of Clinical Nutrition and Dietetics, Children's Health Ireland at Crumlin, Dublin, Ireland.
Insights
Infants with univentricular congenital heart disease experience significant nutritional decline, especially in the neonatal period. Early dietitian intervention is crucial for improving nutritional support and preventing growth stunting in these vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Nutritional Science
- Congenital Heart Disease
Background:
- Univentricular congenital heart disease (UCHD) presents complex challenges for infant nutrition.
- Early nutritional status significantly impacts outcomes in infants undergoing cardiac surgery.
Purpose of the Study:
- To evaluate the nutritional status and early nutritional intake of infants with UCHD.
- To identify critical periods for nutritional decline and intervention.
Main Methods:
- Retrospective analysis of 90 infants undergoing Norwood procedure or hybrid intervention (stage 1).
- Collection of demographic, anthropometric, nutritional intake, and morbidity data.
- Assessment of weight-for-age z-score (WAZ) and length-for-age z-score (LAZ) at different stages.
Main Results:
- A significant drop in mean WAZ was observed from birth (-0.01) to post-stage 1 surgery discharge (-1.45).
- At discharge, 32% of infants had WAZ <-2, and 15% were stunted (LAZ <-2) by Fontan surgery.
- Early dietitian referral was associated with shorter time to nutrition support and target caloric intake.
Conclusions:
- Nutritional status declines most significantly during the neonatal period in infants with UCHD.
- Growth stunting is evident by the time of Fontan procedure, highlighting the need for sustained nutritional support.
- Early and proactive dietitian involvement is critical for optimizing nutritional intake and outcomes in this high-risk population.
Objectives:
To evaluate the nutritional status and early nutritional intake of infants with univentricular congenital heart disease.
Study Design:
The included infants underwent a Norwood procedure or hybrid intervention (stage 1) within the first 6 weeks of life, between January 2014 and January 2019, at Children's Health Ireland at Crumlin. Demographic, anthropometric, nutritional intake, and morbidity data were collected.
Results:
Data were collected on 90 infants and 1886 neonatal admission days. There was a significant drop in mean weight-for-age z-score (WAZ) between measurements at birth, -0.01 and on discharge post stage 1 surgery -1.45 (P < .01). On hospital discharge (median hospital stay, 25 days) 32% of infants had a WAZ <-2 and 11% had a WAZ <-3. Pre-stage 1, 26% received trophic feeds and 39% received parenteral nutrition. Basal metabolic requirements and target caloric intake (120 kcal/kg) were met on 56% and 13% of admission days, respectively. Infants referred to a dietitian had a shorter time to any form of nutrition support, enteral feeds, and target caloric intake (P < .001, P = .016, and P = .048, respectively). At stage 3 (Fontan) surgery, 15% of infants were classified as stunted (length-for-age z-score [LAZ] <-2).
Conclusions:
The greatest decline in nutritional status occurs in the neonatal period, followed by significant growth stunting by the time of the Fontan procedure. Early involvement of dietitians is critical in the care of this nutritionally fragile group. With the currently low rate of preoperative nutritional support, there may be opportunities to improve intake at this critical stage.
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