Feeding Difficulties and Growth Delay in Children with Hypoplastic Left Heart Syndrome versus d-Transposition of the Great Arteries

Abstract

The objective of this study was to identify the incidence of feeding difficulties in infants with hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA). Congenital heart disease is a risk factor for growth failure. The etiologies include poor caloric intake, inability to utilize calories effectively, and increased metabolic demands. The goals of our study were to (1) identify feeding difficulties in infants with HLHS and d-TGA and (2) assess their growth in the first year of life. We performed a chart review of 27 consecutive infants with HLHS and 26 with d-TGA. Descriptive statistics were generated for demographic and clinical variables within each group and are presented as means +/- standard deviations. HLHS and d-TGA groups were compared on time to achieving nutritional goals using the log rank test, on complication rate using the chi-square test, and on weight using the t-test. A significance level of 0.05 was used for all tests. Birth weight was similar for both the HLHS and d-TGA groups (3.19 +/- 0.69 vs 3.35 +/- 0.65 kg, respectively; p = 0.38). Infants with HLHS weighed less than those with d-TGA at l month (3.29 +/- 0.58 vs 3.70 +/- 0.60 kg, respectively; p = 0.021), 6 months (6.27 +/- 1.06 vs 7.31 +/- 1.02 kg, p = 0.003), and 12 months of age (8.40 +/- 1.11 vs 9.49 +/- 1.01 kg, p = 0.006). Time to achieving full caloric intake (at least 100 kcal/kg/day) for the HLHS group (24 +/- 11.9 days) was significantly longer than for the d-TGA group (12.0 +/- 11.2 days, p < 0.001). In addition, infants with HLHS had a higher incidence of feeding-related complications that those with d-TGA (48 vs 4%, respectively; p = 0.001). Compared to the d-TGA group, infants with HLHS weighed less at follow-up, took longer to reach nutritional goals, and had a much higher incidence of feeding-related complications.

Unilateral Vocal Fold Paralysis After Congenital Cardiothoracic Surgery: A Meta-analysis

“…Thirty-two studies that satisfied the inclusion criteria were included in the analysis (Fig 1). OCEBM levels of evidence varied from level 3 (9 studies) [9][10][11][14][15][16]20,23,26 to level 4 (23 studies) [6][7][8]12,13,[17][18][19]21,22,24,25,[27][28][29][30][31][32][33][34][35][36][37] ( Table 1). Occurrence of UVFP, type of surgery, patient demographics, and vocal fold assessment are reported in Table 1.…”

Enteral Feeding of Neonates with Congenital Heart Disease

“…In another study comparing infants with hypoplastic left heart (HLHS) and transposition of great arteries (TGA), the time to achieving full caloric intake (at least 100 kcal/kg/day) for the HLHS group (24 8 11.9 days) was significantly longer than for the d-TGA group (12.0 8 11.2 days, p ! 0.001) [12] . In addition, infants with HLHS had a higher incidence of feeding-related complications (reflux disease, aspiration, poor suck/swallow) than those with d-TGA (48 vs. 4%, respectively; p = 0.001).…”

“…A few previous studies have examined the incidence and clinical impact of gastro-intestinal morbidity among neonates with hypoplastic left heart following the first stage palliation [2,12] . Among 117 infants, gastrointestinal complications occurred in 48 (41%) and included 18% with NEC, 18% with home feeding tubes and 8% who required a prolonged hospital stay for nutritional support [2] .…”

Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

“…1 Additionally, several studies have consistently reported that malnutrition, ranging from mild undernutrition to complete failure to thrive, 2 is a common cause of morbidity in children with CHD. [3][4][5] Multiple factors contribute to growth impairment and malnutrition in infants and children with CHD, such as prenatal and genetic factors, hypoxia and hemodynamic factors, such as congestive heart failure, inadequate nutritional intake, swallowing dysfunction, gastroesophageal reflux, immaturity of the gastrointestinal tract, a hypermetabolic state, and nutrient malabsorption, [6][7][8] as well as psychosocial and hormonal factors. 9,10 However, in medically partially underserved nations such as Indonesia, poor access to care leads to late presentation of patients with CHD and also contributes to malnutrition.…”