Medoff-Cooper Barbara, Naim Maryam, Torowicz Deborah, Mott Antonio
Division of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States of America.
Cardiol Young. 2010 Dec;20 Suppl 3:149-53. doi: 10.1017/S1047951110001228.
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.
在美国，每年约有4000名婴儿出生时患有先天性心脏畸形。患有需要进行复杂手术姑息治疗或确定性修复的心脏缺陷的儿童，在实现最佳短期和长期生长方面面临诸多挑战。合并染色体异常、紫绀和心力衰竭会增加复杂性和挑战。在本综述中，我们探讨与新生儿心脏手术后婴儿的喂养、生长和营养相关的三个主题：乳糜胸后的营养挑战；手术后的母乳喂养；以及出院后的喂养挑战。乳糜胸是儿童心胸手术后罕见的并发症。患有乳糜胸的儿童会因乳糜液中的蛋白质流失、血容量不足和电解质流失而继发营养消耗。尽管有证据支持在早产儿中使用母乳和母乳喂养，但对于患有严重心脏病的婴儿，使用母乳的障碍似乎仍然存在。然而，母乳是健康、早产或患病婴儿首选的营养形式。有充分记录表明，在复杂的新生儿心脏手术后，医疗团队和家庭都在为婴儿喂养问题而困扰。父母将喂养孩子描述为困难、耗时且令人焦虑。乳糜胸等医疗并发症、母乳获取受限以及父母对喂养的担忧和压力，只是可能导致营养和生长不良结局的众多因素中的三个。有确凿证据表明，必须通过生理和行为策略来解决这个多因素问题。
