Postoperative resting energy expenditure in children with congenital heart disease

Abstract

Objective To determine postoperative resting energy expenditure (REE) in children with congenital heart disease (CHD) requiring open heart surgery, to compare measured resting energy expenditure(MREE) with current predictive equations (PEE), and to investigate the possible influencing factors on the metabolic status of the postoperative CHD children. Methods From February 2015 to June 2015, 150 ventilated children admitted to the cardiac intensive care unit after surgery for congenital heart disease in Shanghai Children's Medical Center were enrolled consecutively. Indirect calorimetry (IC) measurements were performed using metabolic cart 4 hours after surgery. General clinical data were recorded. Results Totally 104 male and 46 female patients were enrolled, with a median age of 14 months (8.3-36.0 months). The non-protein respiratory quotient of patient was 0.79±0.20, MREE was (264.76±61.74)kJ/(kg·d), and PEE using Schofield equations was (278.51±93.42)kJ/(kg·d). Although there was no significant differences (P=0.096) between MREE and PEE, the agreement was poor between them (R2=0.119). Multivariate stepwise regression analysis showed that MREE had significant positive correlation with risk adjustment in congenital heart surgery(RACHS-1) score(P=0.012) and negative correlation with age (P=0.010). Up to 97.33% of children(146/150) had lower energy intake compared with MREE on the 1st postoperative day. Conclusions MREE does not increase after surgery in CHD children; however, the substrate utilization is influenced. Factors influencing the postoperative REE include RACHS-1 score and age. The energy intake at 1st day after surgery is generally lower than REE in these children. Key words: Children; Congenital heart disease; Resting energy expenditure; Indirect calorimetry