Diagnosis and treatment of nutritive insufficiency in newborns with congenital heart diseases

Aim. Importance studying of clinical and biochemical signs within the nutrition status estimation and diet therapy effectiveness in children with congenital heart diseases (CHD) in newborn period.
Methods. Clinical and morphometric data were studied in 52 newborn children with different variants of feeding (brest-feeding, adaptive milk formula, pre-milk formula), which created 3 groups: the first group – 23 children with CHD without heart failure (HF), the second one – 16 children with CHD and HF, the third one included 13 newborn children of the corresponding gestation age, weight and age without CHD and other congenital defects as well as general infectious. the data were analyzed on the 10th and 20th days of birth.
Results. Feeding children with various diseases, including CHD with varying degrees of severity of HF, with breast milk is preferable and su൶cient up to 10 days of life, provided that the nutrients are not lower than the physiological level. After 10 days of life, children with CHD underwent dietotherapy correction, prescribed hypercaloric nutrition, taking into account somatometric data and the values of biochemical parameters (prealbumin, urea, transferrin). Diet therapy optimization was done after the 10th day and hypercaloric feeding was prescribed. Increase of calorific value was reached due to pre-milk formula prescribing as a main kind of feeding as well as supplements together with saving breast-feeding if it was available. To the 20th day all babies with CHD and HF had more proteins, fats, carbohydrates and calories. In such a case the level of proteins, urine, transferrin, prealbumin in hemolymph didn’t differ in comparing groups, having different nutrition supplement.
Conclusion. Children with CHD with HF have high protein and energetic exigencies. Differential hypercaloric feeding prescribing taking in consideration somatometric data and biochemical signs (prealbumin, urine, transferrin) as a pre-milk formula allowed to grade energetic deficit and provide biochemical hemostasis.

1. Bokeriya LA., Milievskaya E.B., Gudkova R.G. The relevance of developing the concept of rehabilitation care for patients with congenital heart disease. Children’s heart and vascular diseases. 2012; (1): 63-6. (In Russian)

2. Tsoi E.G., Tsigelnikova L.V., Igisheva L.N., Zhuravleva I.A. Nutritional provision of infants with congenital heart disease. Mother and Baby in Kuzbass. 2016; (3): 19-25. (In Russian)

3. National feeding program for children of the first year of life in the Russian Federation. Moscow; 2010. (In Russian)

4. Pokrovsky VM. Human physiology. Moscow: Medicine; 2003; 343. (In Russian)

5. Neonatology: national manual. Volodin N.N., editors. Moscow: GEOTAR-Media, 2007; 848. (In Russian)

6. Dietology. 4th ed. Baranovsky AYu, editors. St. Petersburg: Peter, 2012; 1024. (In Russian)

7. Parenteral and enteral nutrition: national manual. Khubutia M.Sh., Popova T.S., Saltanova A.I. editors. Moscow: GEOTAR-Media, 2015; 800. (In Russian)

8. Gandaeva L.A., Borovik T.E., Basargina Ye.N., Zvonkova N.G., Skvortsova V.A., Semyonova N.N. The relevance of assessment of nutritional status in children with chronic heart failure. Voprosy sovremennoj pediatrii. 2015; 14(6): 699-705. (In Russian)

9. Rodman M., Mack R., Barnoya J., Castañeda A., Rosales M., Azakie A. et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Sur. 2014; 147(1): 442-450. doi: 10.1016/j.jtcvs.2013.03.023.

10. Toole B.J., Toole L.E., Kyle U.G., Cabrera A.G., Orellana R.A., Coss-Bu J.A. Perioperative nutrition support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis. 2014; 9(1): 15-25. doi: 10.1111/chd.12064.

11. Guide to parenteral and enteral nutrition. Horoshilov I.E., editors. St. Petersburg: Normed. Published, 2000; 376. (In Russian)

12. Kapoor P.M., Narula J., Chowdhury U.K., Kiran U., Taneja S. Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions. Ann Card Anaesth. 2016; 19(2): 300-305. doi: 10.4103/0971-9784.179633.

13. Macedo M.F., de Sousa M. Transferrin and the transferrin receptor: of magic bullets and other concerns. Inflamm Allergy Drug Targets. 2008; 7(1): 41-52. doi: 10.2174/187152808784165162.

14. Lambert L.A., Perri H., Halbrooks P.J., Mason A.B. Evolution of the transferrin family: conservation of residues associated with iron and anion binding. Comp Biochem Physiol B Biochem Mol Biol. 2005; 142(2): 129-141. doi: 10.1016/j.cbpb.2005.07.007.

15. Ingenbleek Y., Bernstein L.H. Plasma transthyretin as a biomarker of lean body mass and catabolic states. Adv Nutr. 2015; 6(5): 572-580. doi: 10.3945/an.115.008508.

16. Adamkin D.Kh. Nutrition strategies for very low birth weight babies. Baybarina E.N., editors. Moscow: GEOTARMedia, 2013; 176. (In Russian)

17. Mathes M., Maas C., Bleeker C., Vek J., Bernhard W., Peter A. et al. Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at < 32 weeks gestation and < 1500 g birth weight enrolled in a randomized controlled trial – a secondary analysis. BMC Pediatr. 2018; 18(1): 154. doi: 10.1186/s12887-018-1136-5.

18. On the direction of recommendations Assessment of the physical development of children and adolescents. Russian Letter of the Ministry of Health of the Russian Federation dated November 21, 2017 No. 15-2 / 10 / 2-8090 (In Russian)

19. Baggen V.J., van den Bosch A.E., Eindhoven J.A., Schut A.W., Cuypers J.A., Witsenburg M. et al. Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease. Circulation. 2017 Jan 17;135(3):264-279. doi: 10.1161/CIRCULATIONAHA.116.023255. Epub 2016 Nov 3.