Growth, breastfeeding, and total energy expenditure in infants with congenital heart disease
Date
2015
Authors
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Publisher
University of Delaware
Abstract
Background: Approximately 30,000 to 35,000 infants per year are born with a congenital heart defect (CHD); the defects range from mild to more severe in complexity and often affect other aspects of infant health. Infants with congenital heart disease (CHD) often fail to maintain a normal growth pattern when compared to healthy infants of a similar age. Poor growth in infancy can affect many aspects of health such as neuro-developmental attributes, immune function, wound healing, and subsequent growth in childhood. The growth failure observed in some infants with CHD is hypothesized to be due to a combination of inadequate energy intake and increased energy expenditure. There is a gap in the literature, however, regarding contemporary infants with CHD, feeding practices, and total energy expenditure in this population. Objective: This study has two primary aims. The first aim is to design a study to examine factors that affect breastfeeding exclusivity and duration in infants with CHD post-surgical intervention (Aim 1). The second aim is to determine if total energy expenditure (TEE) of infants with CHD post-surgical intervention, differs from healthy (control) infants (Aim 2). Hypothesis: We hypothesize that the challenges of breastfeeding infants with CHD will be similar, in part, to those reported by mothers of healthy infants, with a greater emphasis on concerns related to growth of the infant. It is hypothesized that TEE in infants with CHD, post-surgical intervention, would not be increased compared to healthy controls. Design: To address Aim 1, a longitudinal study of breastfeeding in infants with CHD was designed. This study will recruit 75 infant-mother dyads from the Children's Hospital of Philadelphia's Cardiac Intensive Care Unit. Infant-mother dyads will be followed for 12 months and questionnaires regarding breastfeeding, growth, and other aspects of infant feeding will be administered 9 times over a 12-month period. This study is currently under review with the Institutional Review Board at the Children's Hospital of Philadelphia. To address Aim 2, 26 infants with CHD were recruited at birth from the Children's Hospital of Philadelphia Cardiac Intensive Care Unit and 24 healthy control infants were recruited from the surrounding area. Total energy expenditure was assessed at 3 months and 12 months in healthy control infants and infants with CHD after surgical intervention. Results: The longitudinal study of breastfeeding in infants with CHD is currently under review by the Institutional Review Board at the Children's Hospital of Philadelphia. The study of TEE in infants with CHD after surgical intervention found that TEE for CHD infants was not significantly different from healthy infants at 3 months and 12 months; TEE in CHD infants was 36.4 kcal/day higher (95% CI: -46.3, 119.2; p = 0.37) and 31.7 kcal/day higher, (95% CI: -71.5, 134.8; p = 0.53) at 3- and 12- months, respectively, compared to healthy infants. Conclusion: There was no significant difference found in measured TEE between infants with CHD who had undergone surgical intervention within the first 30 days of life and healthy age-matched controls, at 3 months or 12 months of age. As such, the growth failure observed in these infants is likely due to decreased energy intake rather than increased energy expenditure. A focus on understanding and optimizing nutrient intake in this population is needed to support age appropriate growth in infants with CHD.