Breastfeeding Infants With Congenital Heart Disease - An Overview

Introduction:

The heart's abnormality present at birth is known as congenital heart disease (CHD). Various types of congenital heart disease can affect the walls, valves, or the heart's blood vessels. However, these diseases are treatable, and the mode of treatment may depend on the type and severity of the condition. Many mothers get confused about whether to breastfeed when their infants get diagnosed with congenital heart disease. Studies found that it is safe to breastfeed infants with congenital heart disease and provides many benefits. But when the newborn is diagnosed with congenital heart disease, the mother may be unable to breastfeed as the baby is taken away for observation and treatment planning. Hence, the mother has to initiate pumping during this period.

What Is Congenital Heart Disease?

Congenital heart disease is defined as a defect in the heart (which can be on walls, valves, or blood vessels) that is present from birth. There are various types of congenital heart disease, and the symptoms depend on the type and severity of the condition. Some cases can be mild, while others can be life-threatening and require extensive treatment. Congenital heart disease affects 8 to 9 out of every 1,000 live births, making it the most prevalent form of birth abnormality.

A newborn or an infant with congenital heart disease usually presents with the following symptoms;

• Cyanosis (blue, purple, or gray colored skin, lips, or nail beds, which occurs due to decreased amount of oxygen in blood).

• Fatigue or severe tiredness.

• Breathlessness or difficulty in breathing.

• Low birth weight.

• Difficulty in feeding.

• Delay in growth or development.

• Poor blood circulation.

• Chest pain.

• Dizziness.

There are various risk factors that may predispose congenital heart disease. Some of them are:

• Heart defect in family members.

• Intake of certain drugs during pregnancy.

• Consuming alcohol or smoking, or taking illegal drugs during pregnancy.

• Mothers with illnesses like diabetes, viral infection, phenylketonuria (a genetic disorder which causes the accumulation of an amino acid called phenylalanine in the body), etc., during pregnancy.

• Defect in chromosomes or genetics.

Congenital heart disease is diagnosed with physical examinations, chest X-ray, electrocardiogram, echocardiogram, magnetic resonance imaging (MRI), and heart catheterization.

The treatment of congenital heart disease depends on the type and severity. Some cases heal on their own, while other cases require treatment. Only 10 % of CHD children in the past few decades had adulthood as their goal. About 90 % of patients are now helped by improvements in diagnosis and therapy. The complications of congenital heart disease include chylothorax (abnormal accumulation of fluid from the lymphatic system called chyle into the space surrounding lungs), necrotizing enterocolitis (a life-threatening condition that affects the intestinal tract of the newborns or infants), endocarditis (infection affecting the heart lining or its valves), sepsis, etc.

Can Breastfeeding Help Infants With Congenital Heart Disease?

As breast milk is considered a life-saving medical intervention, it can help infants diagnosed with congenital heart disease in certain ways. Breast milk is the best source of ideal nutrition for infants, and mothers of infants with congenital heart disease must be encouraged to breastfeed. Studies found that breastfed infants with congenital heart disease showed low chances of developing complications like necrotizing enterocolitis, sepsis, infections, etc. It was also found that infants showed improved weight gain and enhanced cardiorespiratory stability while feeding.

Breastfeeding offers benefits such as:

• Breast milk contains antibodies and hence helps in providing immunity to infants.

• It helps in promoting healthy weight gain in infants.

• It promotes ideal growth and development in infants.

• The risk of infections in the middle ear, gut, respiratory tract, and other diseases like sudden infant death syndrome (SIDS), diabetes, leukemia, bowel disease, etc. are reduced in infants who are breastfed.

As infants with congenital heart disease are prone to infections and other diseases, these benefits help to improve their growth as well as to reduce the risk of complications. Breast milk is also easier to digest compared to formula milk. In addition, breastfeeding also increases the bond between the mother and child.

The child acquires more oxygen during breastfeeding compared to bottle feeding. Also, the amount of work done by the child's heart is less compared to that during bottle feeding.

Can Mothers Breastfeed After Infants Surgery?

After the surgery, many mothers wonder when to start breastfeeding their infants. However, it depends on the recovery time of infants from surgery, which could range from a few days to several weeks. Mothers are encouraged to continue pumping their milk to maintain the milk supply during this period. Infants are occasionally fed through a feeding tube following surgery. Until the infant is strong enough to nurse at the breast, the mother can pump the milk and give it to the infant via tube or bottle. Mothers can chat with the doctor or caregiver if they wish to breastfeed first.

How Can Mothers Get Started Pumping?

Pumping of breast milk is very important for mothers of infants with congenital heart conditions to maintain an adequate supply of breast milk. The following tips may help mothers in pumping their breast milk:

• Mothers can produce more milk by using a hospital-grade twin electric breast pump. They can plan on pumping every two to three hours for the first two weeks.

• Selecting the right pump will help in meeting the needs. A breast pump with a proper flange fit helps increase the amount of breast milk pumped and prevents any injury to the breast.

• To try to boost the milk supply, pump more frequently rather than for longer amounts of time.

• Avoid skipping pumping as it can have a negative impact on the supply of breast milk. Pumping even for a shorter duration than usual is better rather than skipping.

• Pumping breast milk with hand expression is also beneficial.

Conclusion:

Mothers of infants diagnosed with congenital heart disease must be encouraged to breastfeed as it is a life-saving medical intervention. Prenatally and throughout the infant's hospital stay, mothers and families must receive evidence-based lactation teaching and support. Breastfeeding infants with congenital heart disease can reduce the risk of disease complications. Some infants will require nasogastric tube feedings of either breastmilk or formula as supplements. Mothers are advised not to quit nursing as a result. Many infants can be fed with a nasogastric tube and breastfed simultaneously.