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Overfeeding and obesity in young children with positive pressure ventilation via tracheostomy following cardiac surgery

Published online by Cambridge University Press:  03 August 2020

Takeshi Tsuda Open the ORCID record for Takeshi Tsuda [Opens in a new window] ,
David A. Hehir ,
Deepika Thacker ,
Allison Lamma ,
Donna Tearl  and
Samuel S. Gidding
Takeshi Tsuda*
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
David A. Hehir
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
Deepika Thacker
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
Allison Lamma
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Clinical Nutrition, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Donna Tearl
Affiliation:
Respiratory Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Samuel S. Gidding
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,Philadelphia, PA, USA
*
Author for correspondence: T. Tsuda, MD, FAAP, FACC, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE19803, USA. Tel: +1 (302)651-6677; Fax: +1 (302)651-6601. E-mail: ttsuda@nemours.org
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Abstract

Objectives:

Infants with CHD requiring positive pressure ventilation via tracheostomy are especially vulnerable to malnutrition following cardiac surgery. Current post-operative feeding recommendations may overestimate the caloric needs.

Design:

We retrospectively studied infants requiring tracheostomy after cardiac surgery. Anthropometric and nutritional data were collected, including caloric goals, weight-for-age z score, length-for-age z score, and weight-for-length z score. Changes in anthropometrics over time were compared to ascertain the impact of nutritional interventions. Data were shown as mean ± standard deviation.

Results:

Nineteen infants with CHD required tracheostomy at 160 ± 109 days (7–364 days), 13 had reparative surgery, and 6 had palliative surgery for single ventricle. The indications for tracheostomy consisted of airway abnormality/obstruction (n = 13), chronic respiratory failure (n = 7), and/or vocal cord paresis (n = 2). Initial maintenance nutritional target was set at 100–130 cal/kg per day. Fourteen patients (73.7%) became obese (maximum weight-for-length z score: 2.59 ± 0.47) under tracheostomy and gastrostomy feeding, whereas five patients did not (weight-for-length z score: 0.2 ± 0.83). Eight obese patients (weight-for-length z score: 2.44 ± 0.85) showed effective reduction of obesity within 6 months (weight-for-length z score: 0.10 ± 0.20; p < 0.05 compared with pre-adjustment) after appropriate feeding adjustment (40–90 cal/kg per day). Overall mortality was high (31.6%) in this population.

Conclusion:

Standard nutritional management resulted in overfeeding and obesity in young children with CHD requiring positive pressure ventilation via tracheostomy. Optimal nutritional management in this high-risk population requires close individualised management by multidisciplinary teams.

Keywords

Cardiac surgeryinfantstracheostomyoverfeedingobesitymalnutrition
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1397 - 1404
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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