The impacts of energy and protein provision on anthropometric changes in infants with critical congenital heart disease

OBJECTIVES: Malnutrition in patients with critical congenital heart disease (CCHD) is associated with worse outcomes, however, feeding challenges, and changes in metabolic demands obscure the relationship between nutrient intake and growth in this patient population. We examined the relationship between nutrition provision (caloric and protein intake) and anthropometric indices (weight-for-age z-score [WAZ], length-for-age z-score [LAZ], and occipital-frontal-circumference-for-age [OAZ]). METHODS: A single-center prospective cohort study of infants admitted to cardiac intensive care at a tertiary care children's hospital with CCHD between January 2020 and August 2023. Changes in weekly anthropometric measures were modeled with weekly protein and energy intake using a generalized estimating equation model, controlling for relevant factors. The effects of meeting protein (at least 2 g/kg/day) and energy (at least 120 kcal/kg/day) goals on anthropometric z-scores were also assessed, with a significance threshold of p < 0.05 and no corrections for multiple comparisons. RESULTS: Thirty-six patients were enrolled (18 male), including eight with single ventricle and 28 with biventricular physiology. Increased energy and protein intake were associated with greater expected improvements in growth parameters. Among patients who met the daily caloric goal of at least 120 kcal/kg, there was a significant increase in change in LAZ. Meeting the protein goal of at least 2 g/kg was not associated with changes in WAZ, LAZ, and OAZ. CONCLUSION: Increased energy and protein provision is associated with greater change in all anthropometric indices in neonates with CCHD demonstrating the importance of nutrition provision in this population.