Malabsorption in Infants with Congenital Heart Disease under Diuretic Treatment

Abstract

Intestinal absorption and its relationship to increased total body water was studied in seven infants with congenital heart disease receiving regular diuretics due to congestive heart failure. All infants and six age-matched healthy controls were studied for a 3-d period during which time all food intake was recorded, stools were collected, and total body water content (TBW) and extracellular water were measured. All the anthropometric measurements were lower in the infants with congenital heart disease compared with healthy controls. Energy and fat excretion in the stools were significantly increased in the group of patients, but when expressed as a percentage of daily caloric intake or as a percentage of the specific intake (e.g. fat excretion1 fat intake x 100). no statistical differences were found. TBW as a percentage of body weight was increased in our patients compared with our controls (84.95 + 5.82% versus 68.65 .t 4.60%;~ = 0.01) and so was extracellular water as a percentage of predicted (200.0 2 18.6% versus 100.9 .t Failure to thrive is commonly observed in infants with CHD (1,2). Different causes have been suggested to play a role in this process, among which are poor caloric intake, increased energy expenditure, and intestinal malabsorption due to intestinal congestion (3). Some patients with CHD fail to gain weight or gain weight insufficiently, in spite of increased energy intake. The question then arises whether one should further increase their energy intake or should look for other causes involved in this process, such as increased malabsorption due to increased caloric content or malabsorption due to congested intestinal wall.The present study was designed to study intestinal absorption in infants with CHD who are on diuretic treatment due t o previous status of congestive heart failure and t o try to correlate intestinal malabsorption with different degrees of increased body water content and different caloric intakes. Increased water content, 7.2%; p = 0.001). A positive correlation was found between energy and fat excretion as a percentage of the intake and TBW as a percentage of predicted; energy and fat malabsorption did not exceed 8% in the patients with the highest body water content (120% of predicted). It is concluded that malabsorption is not a significant factor in failure to thrive of patients with congenital heart disease who are receiving regular diuretics. Based on the significant negative correlation between excess body water and fat and calorie absorption, however, it is suggested to monitor TBW in patients who fail to gain weight. (Pediatr Res 36: [545][546][547][548][549]1994) Abbreviations CHD, congenital heart disease TBW, total body water content ECW, extracellular water reflected by increased TBW and ECW in patients with significant intestinal malabsorption, may indicate a possible relationship between these parameters. METHODSThe study population consisted of seven infants with CHD and six age-matched normal controls. Patients' characteristics are given in Table 1....

Energy expenditure in infants with congenital heart disease, including a meta-analysis

“…Faecal energy excretion was not abnormal. These results are in accordance with the literature (1). It should be noted that the present study was cross-sectional, and caution should be applied when making inferences about causality.…”

Medical Management of Chronic Heart Failure in Children

“…Vaisman et al [8] observed that compared with healthy controls, such infants had excess total body water and more extracellular water, as a percentage of that predicted, but no difference in fat excretion as a percentage of daily caloric intake. Owing to the increased metabolic activity of respiratory effort and other metabolic demands associated with CHF, these infants require a higher calorific intake.…”

Nutrition in Congenital Heart Disease: Challenges, Guidelines and Nutritional Support

“…Suboptimal intake due to anorexia, inefficient feeding, and fatigue are also common contributors of inadequate consumption. Malabsorption has also been investigated as a route of energy loss [20,27,28], but data have been inconsistent regarding its significance. Sondheimer and Hamilton reported that protein malabsorption was present in 50 % of infants with either CHF or cyanosis, while steatorrhea occurred mostly in cyanotic patients [20].…”

“…This level of energy loss is out of proportion with the degree of observed growth failure. Further investigation is thus warranted in infants and children with CHD who fail to grow [28].…”