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Description
EBP
Introduction: Infants with congenital heart disease (CHD) are at risk for malnutrition and failure to thrive (FTT). Preoperative nutritional status impacts postoperative outcomes; thus nutrition should be optimized before surgery. Unrepaired infants have higher energy requirements & fluid restrictions, posing challenges in promoting growth for surgery. Energy and nutrient-dense formula has successfully treated FTT in the postoperative phase, however, evidence is limited in unrepaired infants.
Case Description: The case presented is a 4-month ex-36 week infant, past medical history significant for CHD with large ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis and solitary kidney. Following discharge after birth, numerous formula changes were made due to concerns for significant weight loss, dropping below 3rd percentile by 3 weeks. Attempts to increase caloric density with hydrolyzed powdered formula resulted in persistent symptoms of vomiting, constipation and skin sensitivities. While changing to a partially hydrolyzed low lactose formula improved symptoms, weight gain couldn’t be achieved despite 27kcal/oz density. At 5 weeks patient was admitted with severe malnutrition/FTT, initiating tube feedings and reflux medication for emesis. Multiple readmissions occurred for weight concerns and feeding intolerance despite attempts to implement a suitable formula and medication regimen. At 10 weeks they initiated an energy and nutrient-dense formula which ultimately yielded rapid improvement in weight gain in subsequent weeks awaiting surgery. Prior to converting the patient gained 0.53 grams per day and the subsequent 44 days averaged 22.6 grams per day of weight gain. The patient saw improvement in constipation but retching and emesis continued.
Conclusion: Patients with left to right shunts are at risk of FTT & feeding intolerance. A severely malnourished patient demonstrated inability to increase caloric density with standard hydrolyzed formulas. Converting to low osmolality nutrient-dense formula yielded improved tolerance and weight gain, a pattern mirroring prior studies. In the setting of reduced gut perfusion, lower osmolarity formula may facilitate enhanced intestinal absorption and should be explored in a larger sample.
Publication Date
9-27-2024
Keywords
EBP, Evidence-Based Pracitce, Evidence-Based Nursing, Failure to Thrive, Congenital Heart Disease
Disciplines
Pediatric Nursing
Recommended Citation
Birely, Alexandra and Dundas, Sarah, "Management of Failure to Thrive in an Infant with Unrepaired Congenital Heart Disease: A Case Study on Energy and Nutrient Dense Formula" (2024). 2024. 34.
https://scholarlycollection.childrens.com/nursing-anf2024/34
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