Feeding dysfunctions and failure to thrive in neonates with congenital heart diseases

Abstract

Congenital heart disease (CHD) is the most common neonatal congenital malformation. The variety and severity of clinical presentation depend on the cardiac structures involved and their functional impact. The management of newborns with CHD requires a multidisciplinary approach, in which the nutritional aspect plays an important role. An adequate caloric intake during either preand post-surgical period, in fact, improves the outcome of these patients. In addition, the failure to thrive of these children in childhood has been related to long-term cognitive delay (attention deficit disorders, aggressive behaviour and poor social and emotional development). To date, there is a lack of standardized feeding protocols and caloric goals about how to feed neonates with CHD, and current practice varies widely between centres. The latest American Society for Parenteral and Enteral Nutrition guidelines reiterate the importance of proteins, and recommend early start of enteral nutrition, also in the most severe heart diseases, such as univentricular forms. Necrotizing enterocolitis (NEC), the most frequent and feared complication of early feeding of these newborns, often represents an obstacle in spreading this practice. Furthermore, as demonstrated in premature infants, breastfeeding seems to reduce the incidence of NEC. That is why breastfeeding must be encouraged, even if it can be difficult for these mothers due to delivery complications, associated with infant disease. In addition, eating difficulties may persist even after discharge, because these patients require nutritional support through nasogastric tubes or percutaneous endoscopic gastrostomies.

Profile of Acyanotic Congenital Heart Defect in Children at Dr. Soetomo General Hospital Surabaya Period of January – December 2016

“…6 Acyanotic congenital heart defect also tends to cause congestive heart failure, that leads to decrease in cardiac output and water and salt retention. 7 Therefore, the tissue oxygen demand is not met optimally and causes the child growth to be hampered. 7 Other than that, symptoms experienced by children with congestive heart failure such as dyspnea and tachypnea that appear during eating cause children to feel tired, loss of appetite, and lead to a decrease in the quantity of food consumed by children.…”

“…7 Therefore, the tissue oxygen demand is not met optimally and causes the child growth to be hampered. 7 Other than that, symptoms experienced by children with congestive heart failure such as dyspnea and tachypnea that appear during eating cause children to feel tired, loss of appetite, and lead to a decrease in the quantity of food consumed by children. 8 Decrease of ghrelin in blood is also noted in acyanotic congenital heart defect patients.…”

“…6 Increased levels of leptin in the blood also causes activation of the melanocortin system, which then increases the body's energy expenditure and decreases appetite. 7 The presence of concomitant infections also plays an important role through release of proinflammatory cytokines such as TNF-α which induces cell apoptosis, tissue proteins breakdown, and increases leptin secretion into the blood. 7 This mechanism causes the body's protein reserves to decrease, decreased appetite, and increased body's energy expenditure.…”

“…7 The presence of concomitant infections also plays an important role through release of proinflammatory cytokines such as TNF-α which induces cell apoptosis, tissue proteins breakdown, and increases leptin secretion into the blood. 7 This mechanism causes the body's protein reserves to decrease, decreased appetite, and increased body's energy expenditure. 7 There was also an association between chronic hypoxemia and endocrine function in patients with congenital heart defect.…”

“…7 This mechanism causes the body's protein reserves to decrease, decreased appetite, and increased body's energy expenditure. 7 There was also an association between chronic hypoxemia and endocrine function in patients with congenital heart defect. 8 Chronic hypoxemia can cause a decrease in IGF-1 levels in the blood, a peptide that plays in important role in growth, so that the growth of body tissue cannot be achieved optimally.…”