Energy expenditure in children with congenital heart disease, before and after cardiac surgery.
Failure to thrive is a common feature of children with congenital heart disease. Whether this is the result of poor nutrition or an abnormally high basal metabolic rate is unknown, yet the state of nutrition has a profound effect on the metabolic response to injury and strongly influences the outcome of surgical treatment. The aim of this study was therefore to measure the preoperative and postoperative energy requirements of children with congenital heart disease. Eighteen children (aged 4 to 33 months) were given two oral doses of doubly labeled water (H2(18)O and 2H2O), the first 1 week before operation and the second 6 hours after the end of cardiac surgery. By measuring the relative loss of each isotope from the body water pool, we were able to calculate the rate of carbon dioxide production and therefore total energy expenditure. In five patients, energy expenditure was clearly elevated, suggesting that a raised basal metabolic rate is an important factor in the observed failure to thrive in at least a proportion of such children. Postoperatively, energy expenditure fell to values below normal for healthy children (not having an operation), which suggests that the stress of surgery leads to smaller energy requirements than have previously been thought.
Mitchell
I M
IM
Department of Cardiac Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland.
Davies
P S
PS
Day
J M
JM
Pollock
J C
JC
Jamieson
M P
MP
D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D002675:Child, Preschool; D004734:Energy Metabolism; D005260:Female; D006330:Heart Defects, Congenital / Q000378:metabolism*; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D012016:Reference Values