Nicholson George T, Clabby Martha L, Kanter Kirk R, Mahle William T
Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Pediatr Cardiol. 2013 Feb;34(2):316-21. doi: 10.1007/s00246-012-0448-8. Epub 2012 Aug 14.
Infants with congenital heart disease have impaired weight gain during the first several months of life. Efforts have focused on improving weight gain and nutritional status during the first months of life. Close examination of the data suggests that the immediate postoperative period is problematic. Etiology of this early growth failure should be identified to develop effective interventions. This is a retrospective study of neonates who underwent modified systemic-to-pulmonary artery shunt, including Norwood palliation, at Children's Healthcare of Atlanta between January 2009 and July 2011. We analyzed growth from time of surgical intervention to hospital discharge. Measures of calculated weight-for-age Z-score (WAZ score) were performed using the World Health Organization's Anthro Software (version 3.2.2, January 2011; WHO, Geneva, Switzerland). Seventy-three patients were identified. Eight patients did not meet inclusion criteria. Complete data were collected on the remaining 65 patients. Median caloric intake patients received was 50.4 [interquartile range (IQR) 41.6 to 63.6] calories/kg/day while exclusively on parental nutrition. At hospital discharge, the median WAZ score was -2.0 (IQR -2.7 to -1.2) representing an overall median WAZ score decrease of -1.3 (IQR -1.7 to -0.7) from time of shunt palliation to hospital discharge. Despite studies showing poor weight gain in infants with congenital heart disease after neonatal palliation, this study reports the impact of hospital-based nutritional practices on weight gain in infants during the immediate postoperative period. Our data demonstrate that actual caloric intake during the cardiac intensive care unit stay is substantially below what is recommended.
患有先天性心脏病的婴儿在出生后的头几个月体重增长受损。人们致力于改善婴儿出生后头几个月的体重增长和营养状况。对数据的仔细研究表明，术后即刻阶段存在问题。应确定这种早期生长失败的病因，以制定有效的干预措施。这是一项对2009年1月至2011年7月期间在亚特兰大儿童医疗保健中心接受改良体肺分流术（包括诺伍德姑息手术）的新生儿进行的回顾性研究。我们分析了从手术干预到出院期间的生长情况。使用世界卫生组织的Anthro软件（版本3.2.2，2011年1月；世界卫生组织，瑞士日内瓦）计算年龄别体重Z评分（WAZ评分）。共确定了73例患者。8例患者不符合纳入标准。对其余65例患者收集了完整数据。仅接受肠外营养时，患者的中位热量摄入量为50.4[四分位间距（IQR）41.6至63.6]卡路里/千克/天。出院时，中位WAZ评分为-2.0（IQR -2.7至-1.2），从分流姑息手术到出院，总体中位WAZ评分下降了-1.3（IQR -1.7至-0.7）。尽管有研究表明新生儿姑息治疗后先天性心脏病婴儿体重增加不佳，但本研究报告了医院营养措施对术后即刻阶段婴儿体重增加的影响。我们的数据表明，在心脏重症监护病房住院期间的实际热量摄入量大大低于推荐量。
