Comparison of growth and feeding method in infants with and without genetic abnormalities after neonatal cardiac surgery.

Alyson R Pierick,Benjamin E Reinking,Trudy A Pierick

doi:10.1017/s1047951120002887

Alyson R Pierick, Benjamin E Reinking + Show 1 more

Open Access

https://doi.org/10.1017/s1047951120002887

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Abstract

Congenital heart disease (CHD) is multifactorial in origin, resulting from an interaction between environmental and genetic factors. Multifactorial growth delay is common in infants with CHD. The impact of a genetic abnormality and CHD on the growth of an infant is lacking in the literature. The aim of this study is to compare the growth and method of feeding following neonatal cardiac surgery in infants with normal versus abnormal genetic testing. A retrospective chart review of neonates who underwent a Risk Adjustment in Congenital Heart Surgery IV-VI procedure between 1 January, 2006 and 22 September, 2016 was performed at our institution. Weight, length, head circumference measurements, and feeding method were collected at birth, time of neonatal surgery, and monthly up to 6 months of age. A total of 53 infants met inclusion criteria, of which 22 had abnormal genetic testing. Approximately 90% of infants were discharged following neonatal cardiac surgery with supplemental tube feeds. At each monthly follow-up visit, more infants were exclusively fed orally: 80% of infants with normal genetics at 5 months post-operative follow-up versus 60% of infants with abnormal genetic testing, although statistically insignificant. Growth was not different among the two groups. Infants with critical CHD with or without genetic abnormalities are at risk for growth delays and many need supplemental tube feeds post-operatively and throughout follow-up. Infants with genetic abnormalities are slower to achieve oral feeds and more likely to require tube feedings. It is important to have a systematic protocol for managing these high-risk infants.

Highlights

Congenital heart disease (CHD) is multifactorial in origin, resulting from an interaction between environmental and genetic factors
In this retrospective chart review, we evaluated newborns with critical CHD who underwent a neonatal cardiac surgery and compared growth and method of feeding of those with normal and abnormal genetic testing
We found that at our centre, there was no difference in growth parameters from birth to 6 months of age in these infants regardless of genetic testing

Summary

Introduction

Congenital heart disease (CHD) is multifactorial in origin, resulting from an interaction between environmental and genetic factors. The aim of this study is to compare the growth and method of feeding following neonatal cardiac surgery in infants with normal versus abnormal genetic testing. Conclusions: Infants with critical CHD with or without genetic abnormalities are at risk for growth delays and many need supplemental tube feeds post-operatively and throughout follow-up. Congenital heart disease (CHD) is the most common congenital malformation, occurring in nearly 1% of newborns.[1] While many infants with CHD have normal life expectancies and require minimal medical care, those with critical CHD (defined as a lesion requiring a Risk Adjustment in Congenital Heart Surgery (RACHS) IV–VI neonatal surgery) frequently require surgery in the neonatal period.[2] Over the last few decades, advances in procedural techniques and post-operative care have improved survival.[3] As a result, attention has shifted to decreasing morbidities and improving long-term quality of life. Optimising nutrition and growth, in the peri- and post-operative period, improves outcomes.[4,5,6,7,8,9] Poor nutrition and growth in the pre-operative period are associated with poor neurodevelopmental outcomes, impaired wound healing, higher infection rates, and longer hospital length of stay.[4,5,10] Growth delay is multifactorial and can be secondary to cardiac failure, non-cardiac anomalies, tachypnea, increased energy expenditures, inadequate caloric intake, gastroesophageal reflux, dysphagia, oral aversion, and vocal cord dysfunction.[4,11,12] Extracardiac malformations, often associated with genetic abnormalities, may contribute to growth delay.[13]

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