From the Research
Failure to thrive in a 5-week-old male with cleft lip and palate and ventricular septal defect (VSD) is likely multifactorial, with primary causes including feeding difficulties, increased energy expenditure from the cardiac defect, and potential genetic syndromes. The primary causes of failure to thrive in this patient include:
- Feeding difficulties related to the cleft abnormalities, which directly impair the infant's ability to create proper suction during feeding, leading to inefficient intake and increased energy expenditure during feeds 1
- Increased energy expenditure from the cardiac defect, as the VSD causes left-to-right shunting of blood, requiring the heart to work harder and increasing the infant's caloric needs by 15-30%
- Potential genetic syndromes, as these anomalies may be part of a broader genetic syndrome that could affect growth independently 2, 3 Management should include:
- Specialized feeding techniques with cleft-specific bottles or nipples (such as Haberman feeders or Pigeon bottles)
- Possible nasogastric tube supplementation for adequate caloric intake (targeting 150-180 kcal/kg/day)
- Fortification of feeds to 24-30 kcal/oz if needed
- Coordination with a multidisciplinary team including cardiology, plastic surgery, and feeding specialists
- Close monitoring of weight gain (targeting 20-30 g/day) is essential, and surgical repair of both the cleft and cardiac defects should be planned according to the child's clinical status and growth parameters 4 Early intervention is crucial as chronic malnutrition during this critical developmental period can have long-term consequences for growth and neurodevelopment. A tiered approach for clinical evaluation and management of higher-risk infants who have experienced a brief resolved unexplained event (BRUE) may also be necessary, prioritizing the diagnosis of time-sensitive conditions for which delayed diagnosis or treatment could impact outcomes 5