Weight Gain In Infants Following Surgery For Congenital Heart Disease

Nutrition Research Newsletter, Sept, 1999 by Dana L. Boctor, Francy Pillo-Blocka, Brian W. McCrindle

Failure to thrive is of major concern in infants and children inflicted with congenital heart disease. It is likely that the cause of this infliction is multifactorial. Causes may include inadequate intake, hypermetabolism, pulmonary hypertension, and depressed protein synthesis. The focus has been on the increased energy needs of this population; however, achieving even normal growth needs is difficult in the infant with congenital heart defects. One reason for this difficulty is that these infants are commonly fluid-restricted. Nasogastric tube feedings are often beneficial, although this means of feeding is not always safe or practical in the home setting and may impact the infant's development of appropriate oral feeding behaviors. A recent study set out to review the common feeding practices and weight gain patterns of infants suffering from congenital heart disease who had undergone cardiac surgery. The purpose was to identify those issues affiliated with suboptimal weight gain in order to determine where nutrition intervention is needed.

The researchers reviewed 24 medical records of infants less than one year of age admitted for repair of congenital heart defects at the Hospital for Sick Children in Toronto, ON, Canada. The medical records were reviewed and the following were noted: age, sex, cardiac diagnosis, feeding route, feeding tolerance, post-surgical daily caloric intakes, admission length and weight as well as daily weights following surgery, and the length of hospital stay.

The median length of hospital stay was 11 days and the median age at surgery was 2.7 months. A net positive weight gain was found in 36% of patients, while a net weight loss was seen in 64% of patients. Bottle-fed infants gained a median of 20 g per day. Infants who were breast-fed and supplemented with bottle feeds gained a median of 5 g per day. Exclusively breast-fed infants lost a median of 49 g per day during their hospital stay. Weight status did not appear to be affected by the type of cardiac malformation.

It was concluded that weight gain following repair of congenital heart defects is suboptimal and that weight status is affected by the method of feeding. Infants who were solely breast-fed appear to be at the greatest risk, as they had negative weight gain following surgery. Increased emphasis needs to be placed on achieving adequate energy during this crucial stage of development, especially in the breast-fed infant.

Dana L. Boctor, Francy Pillo-Blocka, Brian W. McCrindle, Nutrition After Cardiac Surgery for Infants With Congenital Heart Disease, Nutrition in Clinical Practice, 14:111-115 (June 1999) [Correspondence: Brian McCrindle, MD, MPH, Hospital for Sick Children, Division of Cardiology, 555 University Ave., Toronto, ON M5G 1X8, Canada.]