Nutrition and Growth in Neonates Undergoing Cardiac Surgery

Growth failure is a widespread health problem in infants with congenital heart disease, specifically infants with single ventricle heart lesions, including hypoplastic left heart syndrome. Optimizing nutrition delivery for neonates undergoing cardiac surgery is challenging given environmental and physiologic barriers. Concomitant with nutrition delivery challenges, wide practice variations exist among clinicians. Malnutrition and poor growth are associated with poor wound healing, increased infection risk, prolonged hospitalizations, and long-term neurodevelopmental disability, including worse school performance. The cause of early postnatal growth failure is multifactorial and related to the delay in onset of enteral feedings, increased metabolic stress of cardiac surgery, cyanosis, low cardiac output, increased energy expenditure, altered splanchnic perfusion, and gastrointestinal morbidities. In addition, cardiac infants are susceptible to unique complications, including chylothorax, vocal cord dysmotility, and swallowing dysfunction.