Resting Energy expenditure after fontan surgery in children with single-ventricle heart defects

Nilesh M. Mehta*, John M. Costello, Lori J. Bechard, Victor M. Johnson, David Zurakowski, Francis X. McGowan, Peter C. Laussen, Christopher P. Duggan

*Corresponding author for this work

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Background: Data on resting energy expenditure (REE) and oxygen consumption (VO2) after pediatric cardiopulmonary bypass (CPB) will facilitate optimal nutrient prescription. Methods: The authors measured continuous REE and VO2, using an in-line indirect calorimetery (IC) in 30 consecutive children with single-ventricle physiology immediately after Fontan surgery. REE during steady state at 8 hours after surgery was compared with standard equation-estimated energy expenditure (EEE). Patients were classified into 3 groups: hypermetabolic (measured REE [MREE]/EEE ratio >1.2), hypometabolic (MREE/EEE ratio <0.8), and normometabolic (MREE/EEE ratio 0.8-1.2). Demographic, anthropometric, and perioperative clinical characteristics were examined for their correlation with metabolic status. Results: In 26 of 30 patients with completed IC, mean REE at 8 hours after surgery was 57 ± 20 kcal/kg/d, and mean VO2 was 110 ± 35 mL/min. Mean values of VO2 and REE did not change within the first 24 hours after surgery. There was poor correlation between MREE at 8 hours and the EEE using the World Health Organization equation (r = 0.32, P =.11). Most patients (n = 19, 73%) were either normometabolic or hypometabolic. Lack of hypermetabolism was significantly associated with higher intraoperative serum lactate level and positive fluid balance compared with the rest of the group. Conclusions: The authors report a low prevalence of hypermetabolism in children with single-ventricle defects after Fontan surgery. Measured REE had poor correlation with equation-estimated energy expenditure in a majority of the cohort. The absence of increased energy expenditure after CPB will influence energy prescription in this group.

Original languageEnglish (US)
Pages (from-to)685-692
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume36
Issue number6
DOIs
StatePublished - Nov 2012

Keywords

  • Fontan
  • cardiopulmonary bypass
  • congenital heart disease
  • hypermetabolism
  • hypometabolism
  • indirect calorimetry
  • resting energy expenditure (REE)

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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    Mehta, N. M., Costello, J. M., Bechard, L. J., Johnson, V. M., Zurakowski, D., McGowan, F. X., Laussen, P. C., & Duggan, C. P. (2012). Resting Energy expenditure after fontan surgery in children with single-ventricle heart defects. Journal of Parenteral and Enteral Nutrition, 36(6), 685-692. https://doi.org/10.1177/0148607112445581