Effects of Preoperative Nutritional Conditions on Postoperative Recovery in Neonates with Congenital Heart Disease

Authors

  • Luo-Cheng Wu Department of Neonatology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 350001 Fuzhou, Fujian, China; Department of Neonatology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 350001 Fuzhou, Fujian, China
  • Yi-Nan Liu Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 350001 Fuzhou, Fujian, China
  • Ya-Ting Zeng Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 350001 Fuzhou, Fujian, China
  • Qi-Liang Zhang Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 350001 Fuzhou, Fujian, China

DOI:

https://doi.org/10.59958/hsf.7699

Keywords:

congenital heart disease, neonatal, nutrition, gestational age, weight, postoperative recovery

Abstract

Objective: The effects of preoperative nutritional conditions on postoperative recovery in neonates with congenital heart disease (CHD) were evaluated in this study. Methods: A retrospective analysis of data from neonates with CHD who underwent surgery at our hospital from January 2020 to December 2022 was conducted. The relationships between preoperative nutritional conditions and neonatal postoperative recovery were analyzed. Results: Eighty neonates were included in this study. The average gestational age was 38.4 (37, 39.2) weeks, the average birth weight was 3.1 (2.7, 3.4) kg, the average age at surgery was 23 (21, 26) days, and the average preoperative weight was 3.5 (3.0, 3.9) kg. The postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay of preterm neonates were much longer than those of full-term neonates (p < 0.05). In addition, these values were notably greater for neonates with birth weights ≤3 kg than for neonates with birth weights >3 kg (p < 0.05). The correlation analysis suggested that gestational age, birth weight, preoperative weight-for-age z-score (WAZ) and preoperative height-for-age z-score (HAZ) were negatively correlated with postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay. Conclusions: Preterm birth and low birth weight significantly prolong the duration of mechanical ventilation and postoperative intensive care unit and hospital length of stay. More attention should be given to nutritional management during the perioperative period for premature or low-birth-weight neonates with CHD. For neonates with CHD requiring surgery, the time available for nutritional support before surgery is very limited; thus, more attention and guidance are needed for prenatal nutritional strategies.

References

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015; 131: e29–e322.

van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. Journal of the American College of Cardiology. 2011; 58: 2241–2247.

Chen MY, Riehle-Colarusso T, Yeung LF, Smith C, EdS, Farr SL. Children with Heart Conditions and Their Special Health Care Needs - United States, 2016. MMWR. Morbidity and Mortality Weekly Report. 2018; 67: 1045–1049.

Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatric Clinics of North America. 2009; 56: 1143–1160.

Singh N, Gupta D, Aggarwal AN, Agarwal R, Jindal SK. An assessment of nutritional support to critically ill patients and its correlation with outcomes in a respiratory intensive care unit. Respiratory Care. 2009; 54: 1688–1696.

Lambert LM, Pike NA, Medoff-Cooper B, Zak V, Pemberton VL, Young-Borkowski L, et al. Variation in feeding practices following the Norwood procedure. The Journal of Pediatrics. 2014; 164: 237–242.e1.

Blasquez A, Clouzeau H, Fayon M, Mouton JB, Thambo JB, Enaud R, et al. Evaluation of nutritional status and support in children with congenital heart disease. European Journal of Clinical Nutrition. 2016; 70: 528–531.

Williams DGA, Molinger J, Wischmeyer PE. The malnourished surgery patient: a silent epidemic in perioperative outcomes? Curr Opin Anaesthesiol. 2019; 32: 405–411.

Ross F, Latham G, Joffe D, Richards M, Geiduschek J, Eisses M, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiology in the Young. 2017; 27: 1716–1725.

Ross FJ, Radman M, Jacobs ML, Sassano-Miguel C, Joffe DC, Hill KD, et al. Associations between anthropometric indices and outcomes of congenital heart operations in infants and young children: An analysis of data from the Society of Thoracic Surgeons Database. American Heart Journal. 2020; 224: 85–97.

Skillman HE, Wischmeyer PE. Nutrition therapy in critically ill infants and children. JPEN. Journal of Parenteral and Enteral Nutrition. 2008; 32: 520–534.

Golbus JR, Wojcik BM, Charpie JR, Hirsch JC. Feeding complications in hypoplastic left heart syndrome after the Norwood procedure: a systematic review of the literature. Pediatric Cardiology. 2011; 32: 539–552.

Owens JL, Musa N. Nutrition support after neonatal cardiac surgery. Nutrition in Clinical Practice. 2009; 24: 242–249.

Steltzer M, Rudd N, Pick B. Nutrition care for newborns with congenital heart disease. Clinics in Perinatology. 2005; 32: 1017–30, xi.

O'Neal Maynord P, Johnson M, Xu M, Slaughter JC, Killen SAS. A Multi-Interventional Nutrition Program for Newborns with Congenital Heart Disease. The Journal of Pediatrics. 2021; 228: 66–73.e2.

Mitting R, Marino L, Macrae D, Shastri N, Meyer R, Pathan N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatric Critical Care Medicine. 2015; 16: 448–452.

Soares AM. Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study. Arquivos Brasileiros De Cardiologia. 2018; 111: 674–675.

Anderson JB, Beekman RH, 3rd, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. The Journal of Thoracic and Cardiovascular Surgery. 2009; 138: 397–404.e1.

Wallace MC, Jaggers J, Li JS, Jacobs ML, Jacobs JP, Benjamin DK, et al. Center variation in patient age and weight at Fontan operation and impact on postoperative outcomes. The Annals of Thoracic Surgery. 2011; 91: 1445–1452.

Anderson JB, Kalkwarf HJ, Kehl JE, Eghtesady P, Marino BS. Low weight-for-age z-score and infection risk after the Fontan procedure. The Annals of Thoracic Surgery. 2011; 91: 1460–1466.

Wong JJM, Cheifetz IM, Ong C, Nakao M, Lee JH. Nutrition Support for Children Undergoing Congenital Heart Surgeries: A Narrative Review. World Journal for Pediatric & Congenital Heart Surgery. 2015; 6: 443–454.

Trabulsi JC, Irving SY, Papas MA, Hollowell C, Ravishankar C, Marino BS, et al. Total Energy Expenditure of Infants with Congenital Heart Disease Who Have Undergone Surgical Intervention. Pediatric Cardiology. 2015; 36: 1670–1679.

Li J, Zhang G, Herridge J, Holtby H, Humpl T, Redington AN, et al. Energy expenditure and caloric and protein intake in infants following the Norwood procedure. Pediatric Critical Care Medicine. 2008; 9: 55–61.

Nicholson GT, Clabby ML, Kanter KR, Mahle WT. Caloric intake during the perioperative period and growth failure in infants with congenital heart disease. Pediatric Cardiology. 2013; 34: 316–321.

Martins DS, Piper HG. Nutrition considerations in pediatric surgical patients. Nutrition in Clinical Practice. 2022; 37: 510–520.

Toole BJ, Toole LE, Kyle UG, Cabrera AG, Orellana RA, Coss-Bu JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenital Heart Disease. 2014; 9: 15–25.

Sochet AA, Ayers M, Quezada E, Braley K, Leshko J, Amankwah EK, et al. The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease. Cardiology in the Young. 2013; 23: 896–904.

Steurer MA, Schuhmacher K, Savla JJ, Banerjee M, Chanani NK, Eckhauser A, et al. Fetal growth and gestational age improve outcome predictions in neonatal heart surgery. The Journal of Thoracic and Cardiovascular Surgery. 2022; 164: 2003–2012.e1.

Costello JM, Pasquali SK, Jacobs JP, He X, Hill KD, Cooper DS, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation. 2014; 129: 2511–2517.

Steurer MA, Baer RJ, Chambers CD, Costello J, Franck LS, McKenzie-Sampson S, et al. Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease. The Journal of Pediatrics. 2021; 239: 110–116.e3.

Ravishankar C. Feeding challenges in the newborn with congenital heart disease. Current Opinion in Pediatrics. 2022; 34: 463–470.

Published

2024-11-14

How to Cite

Wu, L.-C., Liu, Y.-N. ., Zeng, Y.-T., & Zhang, Q.-L. (2024). Effects of Preoperative Nutritional Conditions on Postoperative Recovery in Neonates with Congenital Heart Disease. The Heart Surgery Forum, 27(11), E1281-E1288. https://doi.org/10.59958/hsf.7699

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