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Van den Eynde J, Bartelse S, Rijnberg FM, Kutty S, Jongbloed MRM, de Bruin C, Hazekamp MG, Le Cessie S, Roest AAW. Somatic growth in single ventricle patients: A systematic review and meta-analysis. Acta Paediatr 2023; 112:186-199. [PMID: 36200280 PMCID: PMC10092582 DOI: 10.1111/apa.16562] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/17/2022] [Accepted: 10/05/2022] [Indexed: 01/13/2023]
Abstract
AIM To map somatic growth patterns throughout Fontan palliation and summarise evidence on its key modifiers. METHODS Databases were searched for relevant articles published from January 2000 to December 2021. Height and weight z scores at each time point (birth, Glenn procedure, Fontan procedure and >5 years after Fontan completion) were pooled using a random effects meta-analysis. A random effects meta-regression model was fitted to model the trend in z scores over time. RESULTS Nineteen studies fulfilled eligibility criteria, yielding a total of 2006 participants. The z scores for height and weight were markedly reduced from birth to the interstage period, but recovered by about 50% following the Glenn procedure. At >10 years after the Fontan procedure, the z scores for weight seemed to normalise despite persistent lower height, resulting in increased body mass index. The review revealed a number of modifiers of somatic growth, including aggressive nutritional management, timing of Glenn/Fontan, prompt resolution of complications and obesity prevention programmes in adolescence and adulthood. CONCLUSION This review mapped the somatic growth of single ventricle patients and summarised key modifiers that may be amendable to improvement. These data provide guidance on strategies to further optimise somatic growth in this population and may serve as a benchmark for clinical follow-up.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA
| | - Simone Bartelse
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Friso M Rijnberg
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Shelby Kutty
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christiaan de Bruin
- Division of Paediatric Endocrinology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia Le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomedical Data sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Yilmaz Ferhatoglu S, Yurdakok O, Yurtseven N. Malnutrition on admission to the paediatric cardiac intensive care unit increases the risk of mortality and adverse outcomes following paediatric congenital heart surgery: A prospective cohort study. Aust Crit Care 2021; 35:550-556. [PMID: 34462193 DOI: 10.1016/j.aucc.2021.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 06/27/2021] [Accepted: 07/03/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Malnutrition is a common problem in children with congenital heart disease, and it increases the risk of adverse outcomes in the postoperative period. OBJECTIVES We aimed to assess the association between malnutrition and cardiac surgery outcomes in paediatric patients aged 0-36 months. METHODS This prospective cohort study was performed in a hospital specialising in paediatric cardiothoracic surgery. Children aged 0-36 months admitted to the paediatric cardiac intensive care unit after elective cardiac surgery between January 2018 and July 2018 were included in the study. We evaluated the patients' demographics and clinical variables, nutritional status, adverse outcomes, and 30-day mortality rates. RESULTS A total of 124 cases met the inclusion criteria. Results showed that the Risk Adjustment for Congenital Heart Surgery score ≥5, underweight status (weight-for-age Z score ≤-2), and stunting (length-for-age Z score ≤-2) were all indicators for increased mortality following congenital heart surgery. Underweight children also spent a prolonged stay in the intensive care unit. Stunting (length-for-age Z score ≤-2) was the most strongly associated variable with mortality. CONCLUSION The results confirm the impact of malnutrition on mortality, postoperative infection, and length of hospitalisation in children undergoing surgery for congenital heart disease.
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Affiliation(s)
- Sibel Yilmaz Ferhatoglu
- University of Health Sciences, Istanbul Siyami Ersek Cardiothoracic Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Okan Yurdakok
- University of Health Sciences, Istanbul Siyami Ersek Cardiothoracic Surgery Training and Research Hospital, Department of Pediatric Cardiovascular Surgery, Istanbul, Turkey.
| | - Nurgul Yurtseven
- University of Health Sciences, Istanbul Siyami Ersek Cardiothoracic Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
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Advancement of a standardised enteral feeding protocol in functional single ventricle patients following stage I palliation using cerebro-somatic near-infrared spectroscopy. Cardiol Young 2020; 30:1649-1658. [PMID: 32829739 DOI: 10.1017/s104795112000253x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Infants with single ventricle following stage I palliation are at risk for poor nutrition and growth failure. We hypothesise a standardised enteral feeding protocol for these infants that will result in a more rapid attainment of nutritional goals without an increased incidence of gastrointestinal co-morbidities. MATERIALS AND METHODS Single-centre cardiac ICU, prospective case series with historical comparisons. Feeding cohort consisted of consecutive patients with a single ventricle admitted to cardiac ICU over 18 months following stage I palliation (n = 33). Data were compared with a control cohort and admitted to the cardiac ICU over 18 months before feeding protocol implementation (n = 30). Feeding protocol patients were randomised: (1) protocol with cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 17) or (2) protocol without cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 16). RESULTS Median time to achieve goal enteral volume was significantly higher in the control compared to feeding cohort. There were no significant differences in enteral feeds being held for feeding intolerance or necrotising enterocolitis between cohorts. Feeding cohort had significant improvements in discharge nutritional status (weight, difference admit to discharge weight, weight-for-age z score, volume, and caloric enteral nutrition) and late mortality compared to the control cohort. No infants in the feeding group with cerebro-somatic near-infrared spectroscopy developed necrotising enterocolitis versus 4/16 (25%) in the feeding cohort without cerebro-somatic near-infrared spectroscopy (p = 0.04). CONCLUSIONS A feeding protocol is a safe and effective means of initiating and advancing enteral nutrition in infants following stage I palliation and resulted in improved nutrition delivery, weight gain, and nourishment status at discharge without increased incidence of gastrointestinal co-morbidities.
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Sahu MK, Singal A, Menon R, Singh SP, Mohan A, Manral M, Singh D, Devagouru V, Talwar S, Choudhary SK. Early enteral nutrition therapy in congenital cardiac repair postoperatively: A randomized, controlled pilot study. Ann Card Anaesth 2017; 19:653-661. [PMID: 27716696 PMCID: PMC5070325 DOI: 10.4103/0971-9784.191550] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery. Methodology: Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee's approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra- and post-operative variables such as cardiopulmonary bypass and aortic cross-clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software. Results: The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day. Conclusions: Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.
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Affiliation(s)
- Manoj Kumar Sahu
- Department of CTVS, Intensive Care for CTVS, All India Institute of Medical Sciences, New Delhi, India
| | - Anuradha Singal
- Department of Dietetics, Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Menon
- Department of CTVS, Intensive Care for CTVS, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Department of CTVS, Intensive Care for CTVS, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Mohan
- Department of Dietetics, Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mala Manral
- Department of Dietetics, Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Singh
- Department of Dietetics, Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - V Devagouru
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Simsic JM, Carpenito KR, Kirchner K, Peters S, Miller-Tate H, Joy B, Galantowicz M. Reducing variation in feeding newborns with congenital heart disease. CONGENIT HEART DIS 2016; 12:275-281. [PMID: 27865060 DOI: 10.1111/chd.12435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/22/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Enteral feeding is associated with decreased infection rates, decreased mechanical ventilation, decreased hospital length of stay, and improved wound healing. Enteral feeding difficulties are common in congenital heart disease. Our objective was to develop experience-based newborn feeding guidelines for the initiation and advancement of enteral feeding in the cardiothoracic intensive care unit. DESIGN This is a retrospective analysis of a quality improvement project. SETTING This quality improvement project was performed in a cardiothoracic intensive care unit. PATIENTS Newborns admitted to the cardiothoracic intensive care unit for cardiac surgery from January 2011 to May 2015 were retrospectively reviewed. INTERVENTION Newborn feeding guidelines for the initiation and advancement of enteral feeding were implemented in January 2012. OUTCOME MEASURES Guideline compliance and clinical variables before and after guideline implementation were reviewed. RESULTS Compliance with the guidelines increased from 83% in 2012 to 100% in the first two quarters of 2015. Preguidelines (January 2011-December 2011): 45 newborns underwent cardiac surgery; 8 deaths prior to discharge; 1 patient discharged from NICU, therefore, N = 36. Postguidelines (January 2012-May 2015): 131 newborns with 12 deaths, 12 admitted from home, 8 in the NICU, 3 on the floor preop, and 3 back transferred, therefore, N = 93. No difference in feeding preop (post 75% vs pre 69%; P = .5) or full po feeds at discharge (post 78% vs pre 89%; P = .2). Mesenteric ischemia was not statistically different postguidelines (post 6% vs pre 14%; P = .14). Length of hospital stay decreased postguidelines (post 27 + 17 d vs pre 34 + 42 d; P < .001). CONCLUSIONS Implementation of experience-based newborn feeding guidelines for initiation and advancement of enteral feeding in the cardiothoracic intensive care unit was successful in reducing practice variation supported by increasing guideline compliance. Percentage of patient's full oral feeding at discharge did not change. Length of hospital stay was reduced although cannot be fully attributed to feeding guideline implementation.
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Affiliation(s)
- Janet M Simsic
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | | | - Kristin Kirchner
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Stephanie Peters
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Holly Miller-Tate
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Brian Joy
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Mark Galantowicz
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, 43205, USA
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Roche SL, Silversides CK. Hypertension, obesity, and coronary artery disease in the survivors of congenital heart disease. Can J Cardiol 2013; 29:841-8. [PMID: 23688771 DOI: 10.1016/j.cjca.2013.03.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/17/2013] [Accepted: 03/17/2013] [Indexed: 10/26/2022] Open
Abstract
Obesity, hypertension, and coronary artery disease are prevalent in the general population and well recognized as contributors to cardiac morbidity and mortality. With surgical and medical advances, there is a growing and aging population with congenital heart disease who are also at risk of developing these comorbidities. In addition, some congenital cardiac lesions predispose patients to conditions such as hypertension or coronary artery disease. The effect of these comorbidities on the structurally abnormal heart is not well understood, but might be very important, especially in those with residual abnormalities. Thus, in addition to surveillance for and treatment of late complications it is important for the congenital cardiologist to consider and aggressively manage acquired comorbidities. In this review we explore the prevalence of hypertension, obesity, and coronary artery disease, discuss congenital lesions that predispose to these conditions and review management strategies for this unique population.
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Affiliation(s)
- S Lucy Roche
- University of Toronto, Division of Cardiology, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Hessel TW, Greisen G, Idorn L, Reimers JI. Somatic growth in 94 single ventricle children -- comparing systemic right and left ventricle patients. Acta Paediatr 2013; 102:35-9. [PMID: 22994405 DOI: 10.1111/apa.12032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/13/2012] [Accepted: 09/14/2012] [Indexed: 12/01/2022]
Abstract
AIM We sought to compare and assess growth in single ventricle children with a systemic right or left ventricle in five time periods: at birth, before neonatal surgery, before the Glenn anastomosis and finally before and after the Fontan operation to 11 years of age. METHODS We reviewed medical records on 116 single ventricle patients operated at Rigshospitalet, Denmark from 1987 to 2007. Surgical procedures, feeding route, hemodynamic variables and anthropometric measurements such as weight and height were registered and converted to z-scores. RESULTS Ninety four single ventricle patients were included for analysis. Gestational age and birth weight was not significantly different between the left and right ventricle group. Before neonatal surgery and before the Glenn anastomosis, both groups showed equal growth retardation. However, a significant difference in catch-up growth was found before the Fontan operation. Thus, patients in the right ventricle group had a smaller median weight-for-age z-score compared with the left ventricle group in the pre-Fontan period (-1.9 and -1.6; p = 0.049) and in the post-Fontan period (-1.1 and -0.7; p = 0.034). CONCLUSION After the Glenn anastomosis single ventricle children with a systemic left ventricle have better weight gain compared with children with a systemic right ventricle.
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Affiliation(s)
| | - Gorm Greisen
- Neonatal Division; Rigshospitalet; Copenhagen; Denmark
| | - Lars Idorn
- Pediatric Cardiology Division; Rigshospitalet; Copenhagen; Denmark
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Matsumoto T, Ando N, Tomii T, Uesugi K. Three-dimensional cortical bone microstructure in a rat model of hypoxia-induced growth retardation. Calcif Tissue Int 2011; 88:54-62. [PMID: 20848090 DOI: 10.1007/s00223-010-9415-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022]
Abstract
Little is known about hypoxia-induced modification of the canal network in the cortical bone despite its involvement in intracortical vascularity and bone blood supply. In this study, we examined the effect of chronic hypoxia on the canal network in postnatal bone. Tibiae were harvested from 4- and 8-week-old rats (hyp-4 and -8, n = 8 each), whose growth was retarded owing to postnatal exposure to hypoxia (12-14% O₂), and from 3- and 4-week-old normoxic rats (cnt-4 and -5, n = 8 each), which were similar in tibial length and cortical cross-sectional area to hyp-4 and -8, respectively. The diaphyseal canals were detected by monochromatic synchrotron radiation CT with a 3.1-μm voxel resolution. The anatomical properties of the canal network were compared between age- or size-matched hypoxic and normoxic groups. The canals were larger in diameter, were more densely distributed and connected, and opened into the marrow cavity with a higher density in hyp-4 than in cnt-4. The canal density and connectivity were also higher in hyp-4 than in cnt-3. The canal diameter, density, and connectivity were smaller in hyp-8 than in cnt-4; however, the densities of endocortical and periosteal canal openings did not differ between hyp-8 and cnt-4. We concluded that chronic hypoxia enhanced the formation of cortical canal networks at the postnatal developmental stage, probably facilitating intra- and transcortical vascularization and bone perfusion accordingly.
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Affiliation(s)
- Takeshi Matsumoto
- Bioengineering Division, Osaka University Graduate School of Engineering Science, Machikaneyama-cho 1-3, Toyonaka 560-8531, Japan.
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Lee SJ, Cho YK, Ma JS. Final height of patients with congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Soon Joo Lee
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwang-Ju, Korea
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Abstract
BACKGROUND Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. Because of an increased risk of necrotizing enterocolitis in this population, clinicians may be reluctant to initiate early enteral feedings. Published guidelines for initiating and advancing enteral feedings in this population are limited. OBJECTIVE To test the safety and efficacy of an enteral feeding algorithm in infants with HLHS following stage I palliation. DESIGN Single-center, prospective case series with historical comparisons. SETTING Pediatric cardiovascular intensive care unit in tertiary care children's hospital. PATIENTS The study group consisted of consecutive patients > or =35 wks gestational age and weight > or =2 kg admitted to our cardiac intensive care unit over an 18-month period following stage I palliation of HLHS (n = 36). Excluded were nonsurvivors, patients supported on extracorporeal membrane oxygenation or those with a history of NEC or fetal intervention. These data were compared with a similar cohort of patients admitted to the cardiac intensive care unit over an 18-month period before the implementation of the feeding algorithm (n = 27). INTERVENTION A feeding algorithm was implemented in the study group in the postoperative period for initiation and advancement of enteral nutrition. MEASUREMENTS AND MAIN RESULTS The median duration of total parenteral nutrition was significantly higher in the control group (116 vs. 51 hrs; p = 0.03) compared with the study group. The median time to achieve recommended daily allowance of calories defined as 108 kcal/kg per day was significantly reduced in the study group (9 vs. 13 days; p = 0.01). Despite the rapid advancement of enteral feedings on the algorithm, there was no incidence of NEC in the study group compared with 11% in the control group. CONCLUSION The use of an enteral feeding algorithm is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.
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Fetal growth among infants with congenital heart defects by maternal race/ethnicity. Ann Epidemiol 2009; 19:311-5. [PMID: 19246208 DOI: 10.1016/j.annepidem.2008.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 12/14/2008] [Accepted: 12/23/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE Congenital heart defects (CHDs) are the most prevalent birth defects. Infants with CHDs more often are small-for-gestational age (SGA) than infants without CHD; however, little is known about racial/ethnic variations in prevalence of SGA or large-for-gestational age (LGA) for infants born with CHDs. This study determined the risk of SGA and LGA for non-Hispanic (NH)-black and Hispanic infants with CHDs. METHODS Data from the Florida Birth Defects Registry were used in a retrospective cohort study of 10,027 live-born infants to resident NH-White, NH-Black, and Hispanic women ages 15-49 years from January 1, 1998, to December 31, 2003, and diagnosed with 11 CHDs. Defect-specific odds ratios and 95% confidence intervals were computed for risk of SGA and LGA by race/ethnicity and adjusted for covariates using multinomial logistic regression. RESULTS After adjusting for covariates, we found there were no statistically significant racial/ethnic differences in risk of SGA. However, NH-Blacks with ventricular septal defect had increased risk of LGA and NH-Blacks with tetralogy of Fallot had decreased risk of LGA compared to NH-Whites. CONCLUSIONS Very few racial/ethnic differences in fetal growth are present among infants with CHD. Further elucidation of the factors involved in fetal growth and the impact of CHD itself on fetal development is needed.
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Hasan BS, Bendaly EA, Alexy RD, Ebenroth ES, Hurwitz RA, Batra AS. Somatic Growth after Fontan and Mustard Palliation. CONGENIT HEART DIS 2008; 3:330-5. [DOI: 10.1111/j.1747-0803.2008.00206.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vogt KN, Manlhiot C, Van Arsdell G, Russell JL, Mital S, McCrindle BW. Somatic Growth in Children With Single Ventricle Physiology. J Am Coll Cardiol 2007; 50:1876-83. [DOI: 10.1016/j.jacc.2007.07.050] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 07/24/2007] [Accepted: 07/31/2007] [Indexed: 11/28/2022]
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Malik S, Cleves MA, Zhao W, Correa A, Hobbs CA. Association between congenital heart defects and small for gestational age. Pediatrics 2007; 119:e976-82. [PMID: 17387169 DOI: 10.1542/peds.2006-2742] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Infants with congenital heart defects may experience inhibited growth during fetal life. In a large case-control study, we addressed the hypothesis that infants with congenital heart defects are more likely to be small for gestational age than infants without congenital heart defects after controlling for selected maternal and infant characteristics. METHODS Using data from population-based birth defect registries, the National Birth Defects Prevention Study enrolled infants with nonsyndromic congenital heart defects (case subjects) and infants without congenital heart defects or any other birth defect (control subjects). Small for gestational age was defined as birth weight below the 10th percentile for gestational age and gender. Association between congenital heart defects and small for gestational age was examined by conditional logistic regression adjusting for maternal covariates related to fetal growth. RESULTS Live-born singleton infants with congenital heart defects (case subjects, n = 3395) and live-born singleton infants with no birth defect (control subjects, n = 3924) were included in this study. Case subjects had lower birth weights compared with control subjects. Small for gestational age was observed among 15.2% of case subjects and among only 7.8% of control subjects. Congenital heart defect infants were significantly more likely to be small for gestational age than control infants. CONCLUSIONS Infants with congenital heart defects are approximately twice as likely to be small for gestational age as control subjects. Small for gestational age status may affect clinical management decisions, therapeutic response, and prognosis of neonates with congenital heart defects. Although the etiology of growth retardation among infants with congenital heart defects is uncertain, further exploration may uncover a common pathogenesis or causal relationship between congenital heart defects and small for gestational age.
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Affiliation(s)
- Sadia Malik
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, AR, USA
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