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Energy expenditure in congenital heart disease
J S Barton1, P C Hindmarsh, C M Scrimgeour
1International Growth Research Centre, Institute of Child Health, London.
Insights
Infants with severe congenital heart disease experience growth failure due to increased total daily energy expenditure (TDEE). Higher energy intake is crucial for normal growth, suggesting early nasogastric feeding for these patients.
Area of Science:
- Pediatric Cardiology
- Metabolic Research
- Nutritional Science
Background:
- Severe congenital heart disease (CHD) is linked to growth failure in infants.
- Understanding energy expenditure is key to addressing failure to thrive in these children.
Purpose of the Study:
- To investigate total daily energy expenditure (TDEE) in infants with severe CHD.
- To determine the energy intake required for normal growth in infants with CHD.
Main Methods:
- Employed the doubly labeled water method over seven days before surgery.
- Studied eight infants diagnosed with severe congenital heart disease.
Main Results:
- Infants exhibited growth failure, with a mean standardized BMI of 80% of expected values.
- Mean TDEE was significantly elevated at 425 kJ/kg compared to healthy infants.
- Energy intake was insufficient, averaging only 82% of estimated average requirements.
Conclusions:
- Elevated TDEE contributes to growth failure in infants with severe CHD.
- An estimated gross energy intake of 600 kJ/kg/day is necessary for normal growth in these infants.
- Early consideration of nasogastric feeding is recommended over energy supplements alone.
Abstract:
Growth failure is a well recognised consequence of severe congenital heart disease. Total daily energy expenditure (TDEE) was investigated in eight infants with severe congenital heart disease to determine whether an increase in this parameter is an important factor in their failure to thrive, and to estimate the energy intake that would be required to allow normal growth. The infants were studied over a seven day period before surgery using the doubly labelled water method. Growth failure was evident; their mean age standardised body mass index was 80% of the expected value. Mean TDEE was 425 kJ/kg, significantly greater than in healthy infants (mean TDEE/kg SD score = +1.4; 95% confidence interval +0.27 to +2.57). In contrast, their energy intake was only 82% of the estimated average requirements. It was estimated that in early infancy a gross energy intake of 600 kJ/kg/day is required for normal growth in patients with congenital heart disease. This is unlikely to be achieved by energy supplements alone and early recourse to nasogastric feeding should be considered.