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Feeding, growth, and nutrition in children with congenitally malformed hearts

Published online by Cambridge University Press:  01 December 2010

Barbara Medoff-Cooper ,
Maryam Naim ,
Deborah Torowicz  and
Antonio Mott
Barbara Medoff-Cooper*
Affiliation:
Division of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America School of Nursing, The University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Maryam Naim
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Deborah Torowicz
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States of America
Antonio Mott
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: B. Medoff-Cooper, The Children’s Hospital of Philadelphia, University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America. E-mail: [email protected]
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Abstract

In the United States of America, approximately 40,000 infants are born annually with congenitally malformed hearts. Children with defects that require complex surgical palliation, or definitive repair, face many challenges in achieving optimal short-term and long-term growth. The presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. In this review, we address three themes related to feeding, growth, and nutrition of infants after neonatal cardiac surgery: nutritional challenges after chylothorax; breastfeeding after surgery; and the challenges of feeding after discharge. Chylothorax is a rare complication following cardiothoracic surgery in children. Children with chylothorax have nutritional depletion secondary to protein losses in chylous fluid, hypovolaemia, and electrolyte losses. In spite of the evidence supporting the use of human milk and breastfeeding in preterm infants, barriers to its use appear to persist in infants with critical cardiac disease. Yet, human milk is the preferred form of nutrition for well, preterm, or ill infants. It is well documented that after complex neonatal cardiac surgery medical teams and families struggle with infant feeding problems. Parents have described feeding their children as difficult, time consuming, and anxiety producing. Medical complications such as chylothorax, limited access to human milk, and parental concerns and stress about feeding are but three of the myriad of factors that may contribute to poor outcomes regarding nutrition and growth. Compelling evidence exists that this multi-factorial problem must be addressed with both physiological and behavioural strategies.

Keywords

Infantcongenital cardiac diseasefeedinghuman milkchylothorax
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 149 - 153
Copyright
Copyright © Cambridge University Press 2010

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