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Gastrointestinal Problems in Children With CHD: Impact and Management

presented by Hema Desai, MS, CCC-SLP, BCS-S, CLEC, NTMTC and Karli Negrin, MS, CCC-SLP

Accrediting Body:

Target Audience:

Levels:
Disclosure Statement:

Financial: Hema Desai is an employee for CHOC Children’s Hospital. She also receives compensation from MedBridge for this course.
Nonfinancial: Hema Desai is a vice-chair for Cardiac Newborn Neuroprotective Network (CNNN). She has no other competing nonfinancial interests or relationships with regard to the content presented in this course.

Financial: Karli Negrin is an employee for Nemours Children’s Health. She also receives compensation from MedBridge for this course.
Nonfinancial: Karli Negrin is a vice-chair for Cardiac Newborn Neuroprotective Network (CNNN) and is a part of the steering committee for Cardiac Neurodevelopmental Outcome Collaborative (CNOC). She has no other competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 48 Minutes; Learning Assessment Time: 62 Minutes

Infants and children with congenital heart defects (CHD) are at high risk for gastrointestinal complications due to altered cardiac physiology and timing of surgical intervention. Gastrointestinal difficulties can impact oral feeding development in young children, impacting growth and nutrition. When working with children with CHD who have feeding difficulties, it is important to understand how the GI system can be affected and how dysfunction in this system can result in oral feeding difficulties. This intermediate course will benefit clinicians working with this population by helping them understand various complications of the GI tract and its impact on growth, nutrition, and oral feeding skill development. Management strategies and nutrition considerations will be discussed.

Learning Objectives
  • Compare the timing of three common surgical interventions for infants born with CHD to the approximate developmental feeding milestone
  • Recognize the impact of CHD on gastrointestinal tract function
  • Determine how to decrease risk for necrotizing enterocolitis in an infant with CHD
  • Implement strategies to reduce discomfort associated with reflux for infants with CHD
  • Create a feeding plan to improve feeding tolerance for children with decreased GI motility associated with CHD
  • Implement feeding strategies to decrease feeding refusal associated with chylothorax in infants with CHD
  • Determine goals for feeding therapy for a child with congestive heart failure
  • Examine the consequences of GI complications on nutrition and growth in children with CHD
  • Implement strategies in collaboration with medical providers to decrease feeding tube dependency in children with CHD

Meet Your Instructors

Hema Desai, MS, CCC-SLP, BCS-S, CLEC, NTMTC

Hema Desai is an inpatient speech pathologist who has worked with infants and children with feeding and swallowing disorders since 2000. She has her board-certification specialties in swallowing and swallowing disorders (BCS-S) and neonatal touch and massage (NTMTC) and is a clinical lactation education counselor (CLEC). Hema is a clinical supervisor for graduate students, as…

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Karli Negrin, MS, CCC-SLP

Karli Negrin is an international public speaker and researcher in the areas of cardiac neurodevelopment, cardiac neuroprotection, and cardiac aerodigestive science. Her primary area of research emphasizes preserving the critical relationship of the parent-child dyad for infants born with congenital heart disease. Karli is a leader in her science and is internationally recognized for her…

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Chapters & Learning Objectives

1. Congenital Heart Defects and Impact on the Gastrointestinal System

Depending on the type of congenital heart defect, gut function can be affected due to altered blood flow and perfusion to the gut. Surgical intervention can also affect vagal nerve function, impacting the aerodigestive tract, resulting in challenges with tolerance and motility. Impaired gut function due to cardiac anatomy and physiology and/or surgery may lead to future feeding challenges.

2. Necrotizing Enterocolitis (NEC)

Infants with CHD are at high risk for NEC secondary to poor gut perfusion from decreased blood flow from the heart, as well as a consequence of cardiopulmonary bypass and cardiac surgery. Some management options can be very restrictive but necessary to prevent further gut damage or even death. However, this can impact oral feeding opportunities and development. The use of breast milk and feeding guidelines can help mitigate the risk of NEC after cardiac surgery.

3. Gastroesophageal Reflux (GER)

Infants with CHD have a higher incidence of GER than other infants. GER is associated with negative feeding experiences, resulting in poor weight gain, respiratory compromise, and oral aversion. Infants with GER often benefit from medical and nonmedical management strategies to decrease associated discomfort.

4. GI Motility Issues

Altered cardiac physiology and the side effects of cardiac surgery may result in motility challenges of the esophagus and the pharynx. Management of motility issues is important to ensure adequate growth and nutrition and to prevent oral aversion.

5. Chylothorax

Another consequence of cardiac surgery that can affect oral feeding development is chylothorax, which is the presence of chyle in the pleural cavity from damage to the lymph ducts during surgery. It can be a potentially life-threatening disorder that is managed by diet changes. However, for infants and newborns, it may disrupt normal oral feeding and cause subsequent oral aversion.

6. Congestive Heart Failure

Complete repair for cardiac defects is not always possible in infancy, resulting in the need for multiple cardiac interventions and/or staged surgeries. Congestive heart failure may occur when a child is close to needing cardiac intervention, resulting in physiologic instability. Feeding therapists who work with children with cardiac defects should understand these symptoms and how to adjust goals and expectations during this time.

7. Consequences of GI Problems

Hypermetabolism is common for children with CHD, with greater energy expenditure at rest than in age-matched healthy children. As a result, weight gain and nutrition are suboptimal, which can be detrimental for necessary surgery. Strategies to facilitate weight gain can be helpful but also have negative consequences. Good communication between the feeding therapist, cardiologist, dietitian, and family is crucial to optimize growth and development.

8. Tube-Feeding and Tube Weaning

Tube-feeding is common for children with CHD, as they have growth challenges due to altered cardiac anatomy and physiology as well as the consequences of cardiac intervention. While studies have shown improved survival rates with supplemental tube feeds, dependency on tube feeds can occur, impacting family/child feeding dynamics and resulting in oral feeding skill delays. Working with the child’s medical team to decrease tube-feeding dependence is a goal for outpatient feeding therapists with the right support.

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