Disruptions in the development of feeding for infants with congenital heart disease

Abstract

Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.

Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review

“…These defects, which are characterized by an intracardiac mixing, require a delicate balance to provide adequate pulmonary and systemic blood flow. Circulatory imbalance may also lead to decreased mesenteric blood flow, resulting in malabsorption, feeding intolerance or intestinal ischemia [ 13 , 18 ]. For example, when repair is postponed for various reasons (such in the case of infants with tetralogy of Fallot (TOF) from developing countries who did not undergo primary complete repair in infancy), children are more hypoxemic and growth-restricted, and have a worse left ventricular ejection fraction [ 19 ].…”

“…CHD characterized by an obstruction to systemic blood flow, such as left ventricular outflow obstruction and aortic arch anomalies, are associated with intra and extra-cardiac mixing, resulting in decreased systemic oxygen saturation and reduced systemic blood flow. The resulting impaired systemic oxygen delivery leads to acute end-organ dysfunction, including compromised mesenteric oxygenation [ 18 ].…”

“…The reasons for interrupting enteral feeding include deterioration in the clinical status, extubation failure and need of mechanical ventilation or respiratory support, placement of chest tubes or central venous catheters, infections/fever, various gastrointestinal issues (such as gastro-esophageal reflux, feed intolerance or emesis, abdominal distention, or presence of bloody stools), sucking/swallowing issues, chronic fatigue, and vocal cord dysmotility. Genetic syndromes, additional non-cardiac anomalies and unknown causes may also influence enteral feeding [ 5 , 6 , 18 , 22 ].…”

Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

“…Congenital heart diseases have long been linked to feeding problems even after several years following cardiac surgery, leading to a substantial number of infants needing nasogastric tubes or GT for nutrition [ 49 , 50 ]. Feeding problems in this group are often a result of poor cardiorespiratory endurance, delayed initiation and transition to oral feeds, and other medical complications related to underlying medical issues [ 51 ]. Prolonged intubation and an increased risk-adjusted congenital heart surgery score seemed to be predictive of feeding problems [ 50 ].…”

Rehabilitation in Pediatric Heart Failure and Heart Transplant

“…Parent education and training are essential components of any feeding therapy provided to infants and young children ( 110 ). Patients with a history of congenital heart disease have increased incidence of baseline feeding and swallowing difficulties ( 111 , 112 ) and may require extensive feeding therapy, extending beyond the inpatient admission, to target acceptance of oral feeds and oral motor skills. Inpatient clinicians should ensure that referrals for feeding therapy through rehab or in the outpatient setting are made.…”