Understanding the Impact of Fluid Restriction on Growth Outcomes in Infants Following Cardiac Surgery

Pediatr Crit Care Med. 2018 Feb;19(2):131-136. doi: 10.1097/PCC.0000000000001408.


Objective: Fluid restriction is reported to be a barrier in providing adequate nutrition following cardiac surgery. The specific aim of this study was to evaluate the adequacy of nutritional intake during the postoperative period using anthropometrics by comparing preoperative weight status, as measured by weight-for-age z scores, to weight status at discharge home.

Design: Prospective cohort study.

Setting: Cardiac ICU at Miami Children's Hospital.

Patients: Infants from birth to 12 months old who were scheduled for cardiac surgery at Miami Children's Hospital between December 2013 and September 2014 were followed during the postoperative stay.

Interventions: Observational study.

Measurements and main results: Preoperative and discharge weight-for-age z scores were analyzed. The Risk Adjustment for Congenital Heart Surgery 1 categories were obtained to account for the individual complexity of each case. In patients who had preoperative and discharge weights available (n = 40), the mean preoperative weight-for-age z score was -1.3 ± 1.43 and the mean weight-for-age z score at hospital discharge was -1.89 ± 1.35 with a mean difference of 0.58 ± 0.5 (p < 0.001). A higher Risk Adjustment for Congenital Heart Surgery 1 category was correlated with a greater decrease in weight-for-age z scores (r = -0.597; p = 0.002).

Conclusions: Nutritional status during the postoperative period was found inadequate through the use of objective anthropometric measures and by comparing them with normal growth curves. Increase in surgical risk categories predicted a greater decrease in weight-for-age z scores. The development of future protocols for nutritional intervention should consider surgical risk categories.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Weight*
  • Cardiac Surgical Procedures / adverse effects*
  • Child Development*
  • Cohort Studies
  • Female
  • Florida
  • Fluid Therapy / adverse effects*
  • Fluid Therapy / methods
  • Heart Defects, Congenital / surgery
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Length of Stay / statistics & numerical data
  • Male
  • Nutritional Status*
  • Postoperative Period
  • Prospective Studies
  • Risk Adjustment
  • Risk Factors