Friday September 4, 2009 (pediatric pearl)
Poor Nutritional status in children with hypoplastic left heart syndrome

Infants with hypoplastic left heart syndrome (HLHS) experience a high incidence of growth failure in the postoperative period following stage I palliation. The growth failure in these infants may be related to insufficient nutritional intake, gastrointestinal malabsorption, or high energy expenditure. Clinicians are often reluctant to initiate and advance early enteral feedings in this population because of the increased risk of necrotizing enterocolitis and the high incidence of feeding intolerance and gastroesophageal reflux diseaseThe risk of developing necrotizing enterocolitis in infants with HLHS is significantly higher than in neonates with other forms of congenital heart disease (CHD).

This may be related in part to compromised diastolic flow in the mesenteric circulation in infants undergoing Stage 1 palliation with either a Blalock Taussig shunt or an right ventricle to pulmonary artery conduit. Some studies have also found increased permeability of gut mucosal barrier in children with CHD undergoing cardiopulmonary bypass.

The use of an enteral feeding algorithm (Pediatr Crit Care Med 2009; 10:460–466) is a safe and effective means of initiating and advancing enteral nutrition in infants with HLHS following stage I palliation.