Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Horsley, Megan; Pathak, Sagar; Morales, David; Lorts, Angela; Mouzaki, Marialena

doi:10.1002/jpen.2351

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…This is similar to reports from previous studies that reported the incidence of malnutrition in pre‐Fontan patients as 19% by WAZ 8 and 9%–18% by WAZ/HAZ 2 . This is much higher than the prevalence reported for hospitalized children in the United States based on administrative data but similar to what has been reported in children with heart failure listed for transplant and in those requiring a ventricular assist device 9,10 . Unlike the heart failure population, moderate‐severe malnutrition persisted in this Fontan population over time, with an average of 1 in 10 patients still meeting the criteria for malnutrition at 10‐years post‐Fontan surgery 10 …”

Section: Discussionsupporting

confidence: 88%

“…Most patients received an extracardiac Fontan conduit (62%) with 38% being fenestrated (Table 1). The median length of hospital stay was 12 days (IQR, [8][9][10][11][12][13][14][15][16][17][18]. Following surgery, 38% of patients had persistent pleural drainage lasting for >2 weeks.…”

Section: Perioperative and Postoperative Follow-upmentioning

confidence: 99%

“…There was no difference in the degree of malnutrition pre-Fontan based on Fontan type. There was a greater proportion of patients with prolonged pleural drainage (>2 weeks) in those that had none-mild malnutrition pre-Fontan compared with the moderate-severe group (44.4% vs 12%; P = 0.04), but there was no difference in postop length of stay between these two groups (12 [IQR,[9][10][11][12][13][14][15][16][17][18] vs 12 [IQR, 7-26]; P = 0.54).…”

mentioning

confidence: 95%

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Incidence and impact of malnutrition in patients with Fontan physiology

Sekhon

Foshaug

Kantor

et al. 2022

J Parenter Enteral Nutr

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Background Single‐ventricle patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in several long‐term complications, but the impact and consequences of nutrition status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on outcomes. Methods This study was a retrospective cohort study of children who underwent Fontan surgery between 1997 and 2018. Clinical, demographic, and nutrition data were collected, including weight, height, body mass index (BMI), and their respective z scores (z score for weight‐for‐age [WAZ], z score for height‐for‐age [HAZ], and z score for BMI‐for‐age [BMIZ]) pre‐Fontan, at discharge, 6 months, and 1, 5, and 10 years post‐Fontan. Malnutrition status was categorized using the American Society for Parenteral and Enteral Nutrition guidelines and the Michigan MTool. Fontan failure was defined as listing for heart transplant or death. Results Of the 69 patients, moderate‐severe malnutrition occurred at any time point in 11% (n = 8) by WAZ, 16% (n = 11) by HAZ, and 6% (n = 4) by BMIZ. Moderate‐severe malnutrition persisted in 6.5%–12.9% at 10 years post‐Fontan. Compared with the pre‐Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre‐Fontan malnutrition. Conclusion There is a 6%–16% incidence of moderate‐severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in follow‐up. There was no association with anthropometric parameters and transplant‐free survival. A prospective multi‐institutional study is needed to understand the impact of malnutrition on long‐term outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Perioperative and Postoperative Follow-upmentioning

confidence: 99%

mentioning

confidence: 95%

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Incidence and impact of malnutrition in patients with Fontan physiology

Sekhon

Foshaug

Kantor

et al. 2022

J Parenter Enteral Nutr

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“…Horsley et al found that after VAD implementation, the percentage of energy intake increased from 77% to 90% at 2 months, and the proportion of patients with malnutrition decreased significantly with improvement in BMI z scores. 119 Hollander et al found that in patients awaiting heart transplantation, those with VADs had a decrease in the presence of moderate to severe malnutrition compared with those treated with medical therapy alone. 120 Thus, in the heart failure population, implementing a VAD may improve nutrition provision both while awaiting and after transplantation.…”

Section: Heart Failure and Heart Transplantmentioning

confidence: 99%

Nutrition for critically ill children with congenital heart disease

Kerstein,

Klepper,

Finnan

et al. 2023

Nut in Clin Prac

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Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter‐based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision‐making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.

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“…Malnutrition is common in pediatric patients with heart failure who are listed for heart transplant (HT). It may persist for years after HT and is associated with increased morbidity and mortality 1–10 . Malnutrition is commonly treated with tube feeds with or without calorically dense feeds during the HT listing (HTL) period.…”

Section: Introductionmentioning

confidence: 99%

Supplemental nutrition, feeding disorders, and renourishment in pediatric heart failure through transplantation

Zook,

Schultz,

Rizzuto

et al. 2023

Pediatric Transplantation

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BackgroundTube feeds are used commonly in children listed for heart transplant; however, rates of renourishment and development of feeding disorders are not sufficiently characterized.MethodsRetrospective review of pediatric heart transplant recipients from January 1, 2014, to January 3, 2021. Demographics, anthropometric, and nutritional data were collected from heart transplant listing through 3 years post‐transplant. Renourishment rates, presence of a feeding disorder, and need for a gastric feeding tube were analyzed. Multivariable analysis was conducted to identify risks for poor nutritional outcomes.ResultsOf 104 patients, 35 (34%) and 36 (35%) were malnourished at heart transplant listing and transplant, respectively, persisting in 21/91 (23%) 1 year postheart transplant. Forty (38%) received tube feeds at listing, 42 (40%) at heart transplant, and 18/90 (20%) 1 year post‐transplant. Rates of feeding disorders fell from 23% at transplantation to 10% 1 year post‐transplant. Feeding disorders were associated with younger age at heart transplant (p < .001) and congenital heart disease (p = .03). Forty‐six percent of infants required a gastric feeding tube. Renourishment occurred in 20% during listing and was associated with ventricular assist device support (p = .03) and noncalorically dense feeds (p = .03). Malnutrition at transplant was associated with inferior post‐transplant survival (6/36 (17%) vs. 2/68 (3%); p = .02).ConclusionsMalnourishment requiring tube feeds is common in pediatric heart transplant candidates; however, most patients who eventually survive to transplant remain malnourished at time of transplantation and 1 year later. While some children develop feeding disorders, they generally resolve by 1 year post‐transplant.

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Nutritional outcomes of patients with pediatric and congenital heart disease requiring ventricular assist devices

Cited by 7 publications

References 17 publications

Incidence and impact of malnutrition in patients with Fontan physiology

Incidence and impact of malnutrition in patients with Fontan physiology

Nutrition for critically ill children with congenital heart disease

Supplemental nutrition, feeding disorders, and renourishment in pediatric heart failure through transplantation

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