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左心发育不全综合征与大动脉 d 型转位患儿的喂养困难和生长发育迟缓

Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries.

作者信息

Davis D, Davis S, Cotman K, Worley S, Londrico D, Kenny D, Harrison A M

机构信息

Division of Pediatrics, The Children's Hospital, Cleveland Clinic, 9500 Euclid Avenue, S20, Cleveland, OH 44195, USA.

出版信息

Pediatr Cardiol. 2008 Mar;29(2):328-33. doi: 10.1007/s00246-007-9027-9. Epub 2007 Aug 9.

Abstract

The objective of this study was to identify the incidence of feeding difficulties in infants with hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA). Congenital heart disease is a risk factor for growth failure. The etiologies include poor caloric intake, inability to utilize calories effectively, and increased metabolic demands. The goals of our study were to (1) identify feeding difficulties in infants with HLHS and d-TGA and (2) assess their growth in the first year of life. We performed a chart review of 27 consecutive infants with HLHS and 26 with d-TGA. Descriptive statistics were generated for demographic and clinical variables within each group and are presented as means +/- standard deviations. HLHS and d-TGA groups were compared on time to achieving nutritional goals using the log rank test, on complication rate using the chi-square test, and on weight using the t-test. A significance level of 0.05 was used for all tests. Birth weight was similar for both the HLHS and d-TGA groups (3.19 +/- 0.69 vs 3.35 +/- 0.65 kg, respectively; p = 0.38). Infants with HLHS weighed less than those with d-TGA at l month (3.29 +/- 0.58 vs 3.70 +/- 0.60 kg, respectively; p = 0.021), 6 months (6.27 +/- 1.06 vs 7.31 +/- 1.02 kg, p = 0.003), and 12 months of age (8.40 +/- 1.11 vs 9.49 +/- 1.01 kg, p = 0.006). Time to achieving full caloric intake (at least 100 kcal/kg/day) for the HLHS group (24 +/- 11.9 days) was significantly longer than for the d-TGA group (12.0 +/- 11.2 days, p < 0.001). In addition, infants with HLHS had a higher incidence of feeding-related complications that those with d-TGA (48 vs 4%, respectively; p = 0.001). Compared to the d-TGA group, infants with HLHS weighed less at follow-up, took longer to reach nutritional goals, and had a much higher incidence of feeding-related complications.

摘要

本研究的目的是确定左心发育不全综合征(HLHS)和大动脉d转位(d-TGA)婴儿喂养困难的发生率。先天性心脏病是生长发育迟缓的一个危险因素。其病因包括热量摄入不足、无法有效利用热量以及代谢需求增加。我们研究的目标是:(1)确定HLHS和d-TGA婴儿的喂养困难情况;(2)评估他们出生后第一年的生长情况。我们对27例连续性HLHS婴儿和26例d-TGA婴儿的病历进行了回顾。对每组的人口统计学和临床变量进行描述性统计,并以均值±标准差表示。使用对数秩检验比较HLHS组和d-TGA组达到营养目标的时间,使用卡方检验比较并发症发生率,使用t检验比较体重。所有检验的显著性水平均为0.05。HLHS组和d-TGA组的出生体重相似(分别为3.19±0.69 kg和3.35±0.65 kg;p = 0.38)。HLHS婴儿在1个月时的体重低于d-TGA婴儿(分别为3.29±0.58 kg和3.70±0.60 kg;p = 0.021),6个月时(6.27±1.06 kg对7.31±1.02 kg,p = 0.003),以及12个月龄时(8.40±1.11 kg对9.49±1.01 kg,p = 0.006)。HLHS组达到完全热量摄入(至少100 kcal/kg/天)的时间(24±11.9天)显著长于d-TGA组(12.0±11.2天,p < 0.001)。此外,HLHS婴儿喂养相关并发症的发生率高于d-TGA婴儿(分别为48%对4%;p = 0.001)。与d-TGA组相比,HLHS婴儿在随访时体重较轻,达到营养目标的时间更长,且喂养相关并发症的发生率高得多。

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