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Feeding, growth, and nutrition in children with congenitally malformed hearts

Published online by Cambridge University Press:  01 December 2010

Barbara Medoff-Cooper ,
Maryam Naim ,
Deborah Torowicz  and
Antonio Mott
Barbara Medoff-Cooper*
Affiliation:
Division of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America School of Nursing, The University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Maryam Naim
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Deborah Torowicz
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States of America
Antonio Mott
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: B. Medoff-Cooper, The Children’s Hospital of Philadelphia, University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America. E-mail: medoff@nursing.upenn.edu
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Abstract

In the United States of America, approximately 40,000 infants are born annually with congenitally malformed hearts. Children with defects that require complex surgical palliation, or definitive repair, face many challenges in achieving optimal short-term and long-term growth. The presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. In this review, we address three themes related to feeding, growth, and nutrition of infants after neonatal cardiac surgery: nutritional challenges after chylothorax; breastfeeding after surgery; and the challenges of feeding after discharge. Chylothorax is a rare complication following cardiothoracic surgery in children. Children with chylothorax have nutritional depletion secondary to protein losses in chylous fluid, hypovolaemia, and electrolyte losses. In spite of the evidence supporting the use of human milk and breastfeeding in preterm infants, barriers to its use appear to persist in infants with critical cardiac disease. Yet, human milk is the preferred form of nutrition for well, preterm, or ill infants. It is well documented that after complex neonatal cardiac surgery medical teams and families struggle with infant feeding problems. Parents have described feeding their children as difficult, time consuming, and anxiety producing. Medical complications such as chylothorax, limited access to human milk, and parental concerns and stress about feeding are but three of the myriad of factors that may contribute to poor outcomes regarding nutrition and growth. Compelling evidence exists that this multi-factorial problem must be addressed with both physiological and behavioural strategies.

Keywords

Infantcongenital cardiac diseasefeedinghuman milkchylothorax
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 149 - 153
Copyright
Copyright © Cambridge University Press 2010

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References

1.Hoffman, J, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
2.Chan, SY, Lau, W, Wong, WH, Cheng, LC, Chau, AK, Cheung, YF. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82: 1650–1656.CrossRefGoogle ScholarPubMed
3.Milonakis, M, Chatzis, AC, Giannopoulos, NM, et al. Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369–373.CrossRefGoogle ScholarPubMed
4.Chan, EH, Russell, JL, Williams, WG, Van Arsdell, GS, Coles, JG, McCrindle, BW. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 1864–1870.CrossRefGoogle ScholarPubMed
5.Nath, DS, Savla, J, Khemani, RG, Nussbaum, DP, Greene, CL, Wells, WJ. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 2009; 88: 246–251; discussion 251-252.CrossRefGoogle ScholarPubMed
6.McBride, ME, Drass, JC, Berkenbosch, JW, Wilson, WR Jr, Tobias, JD. Hypogammaglobulinemia complicating chylothorax after cardiac surgery in two infants. J Cardiothorac Vasc Anesth 2001; 15: 358–361.CrossRefGoogle ScholarPubMed
7.Orange, JS, Geha, RS, Bonilla, FA. Acute chylothorax in children: selective retention of memory T cells and natural killer cells. J Pediatr 2003; 143: 243–249.CrossRefGoogle ScholarPubMed
8.Gershanik, JJ, Jonsson, HT Jr, Riopel, DA, Packer, RM. Dietary management of neonatal chylothorax. Pediatrics 1974; 53: 400–403.CrossRefGoogle ScholarPubMed
9.Cormack, BE, Wilson, NJ, Finucane, K, West, TM. Use of Monogen for pediatric postoperative chylothorax. Ann Thorac Surg 2004; 77: 301–305.CrossRefGoogle ScholarPubMed
10.Hamdan, MA, Gaeta, ML. Octreotide and low-fat breast milk in postoperative chylothorax. Ann Thorac Surg 2004; 77: 2215–2217.CrossRefGoogle ScholarPubMed
11.Chan, GM, Lechtenberg, E. The use of fat-free human milk in infants with chylous pleural effusion. J Perinatol 2007; 27: 434–436.CrossRefGoogle ScholarPubMed
12.Rothman, A, Mayer, JE, Freed, MD. Treatment of chronic pleural effusions after the Fontan procedure with prednisone. Am J Cardiol 1987; 60: 408–409.CrossRefGoogle ScholarPubMed
13.Spatz, DL. State of the science: use of human milk and breast-feeding for vulnerable infants. J Perinat Neonatal Nurs 2006; 20: 51–55.CrossRefGoogle ScholarPubMed
14.Rodriguez, NA, Miracle, DJ, Meier, PP. Sharing the science on human milk feedings with mothers of very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs 2005; 34: 109–119.CrossRefGoogle ScholarPubMed
15.Gartner, LM, Morton, J, Lawrence, RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 496–506.Google ScholarPubMed
16.Furman, L, Taylor, G, Minich, N, Hack, M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003; 157: 66–71.CrossRefGoogle ScholarPubMed
17.Riordan, J. The biological specificity of breastmilk. In: Riordan J (ed.). Breastfeeding and Human Lactation. Jones and Bartlett, Boston, 2004: 97–135.Google Scholar
18.Spatz, DL. Ten steps for promoting and protecting breastfeeding for vulnerable infants. J Perinat Neonatal Nurs 2004; 18: 385–396.CrossRefGoogle ScholarPubMed
19.Spatz, DL. Breastfeeding education and training at a children’s hospital. J Perinat Edu 2004; 14: 30–38.CrossRefGoogle Scholar
20.Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397–404; e391.CrossRefGoogle ScholarPubMed
21.Meier, P. Bottle- and breast-feeding: effects on transcultaneous oxygen pressure and temperature in preterm infants. Nurs Res 1988; 37: 36–41.CrossRefGoogle ScholarPubMed
22.Chen, CH, Wang, TM, Chang, HM, Chi, CS. The effect of breast- and bottle-feeding on oxygen saturation and body temperature in preterm infants. J Hum Lact 2000; 16: 21–27.CrossRefGoogle ScholarPubMed
23.Marino, BL, O’Brien, P, LoRe, H. Oxygen saturations during breast and bottle feedings in infants with congenital heart disease. J Pediatr Nurs 1995; 10: 360–364.CrossRefGoogle ScholarPubMed
24.Bier, JB, Ferguson, A, Anderson, L, et al. Breast-feeding of very low birth weight infants. J Pediatr 1993; 123: 773–778.CrossRefGoogle ScholarPubMed
25.Meier, PP, Engstrom, JL, Crichton, CL, Clark, DR, Williams, MM, Mangurten, HH. A new scale for in-home test-weighing for mothers of preterm and high risk infants. J Hum Lact 1994; 10: 163–168.CrossRefGoogle ScholarPubMed
26.Hughes, M, McCollum, J, Sheftel, D, Sanchez, G. How parents cope with the experience of neonatal intensive care. Child Health Care 1994; 23: 1–14.CrossRefGoogle ScholarPubMed
27.Bu’Lock, F, Woolridge, MW, Baum, JD. Development of co-ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol 1990; 32: 669–678.CrossRefGoogle ScholarPubMed
28.Skinner, ML, Halstead, LA, Rubinstein, CS, Atz, AM, Andrews, D, Bradley, SM. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg 2005; 130: 1293–1301.CrossRefGoogle ScholarPubMed
29.Licht, DJ, Shera, DM, Clancy, RR, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg 2009; 137: 529–536; discussion 536–537.CrossRefGoogle ScholarPubMed
30.Jadcherla, SR, Vijayapal, AS, Leuthner, S. Feeding abilities in neonates with congenital heart disease: a retrospective study. J Perinatol 2009; 29: 112–118.CrossRefGoogle ScholarPubMed
31.Kelleher, DK, Laussen, P, Teixeira-Pinto, A, Duggan, C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22: 237–244.CrossRefGoogle ScholarPubMed
32.Svavarsdottir, EK, McCubbin, M. Parenthood transition for parents of an infant diagnosed with a congenital heart condition. J Pediatr Nurs 1996; 11: 207–216.CrossRefGoogle ScholarPubMed
33.Thommessen, M, Heiberg, A, Kase, BF. Feeding problems in children with congenital heart disease: the impact on energy intake and growth outcomes. Eur J Clin Nutr 1991; 46: 457–464.Google Scholar
34.Medoff-Cooper, B, Irving, S, Bird, GL, et al. Nutritional and growth status of infants with single ventricle physiology. Cardiology 2009; 19 (Suppl. 2): 90–95.Google Scholar