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Nutrition in Congenital Heart Disease: Challenges, Guidelines and Nutritional Support

Reference work entry

Abstract

Infants and children with congenital heart disease have high energy requirements and poor intake and are frequently malnourished. Delivering adequate nutrition is challenging and may be difficult due to fluid limitations, feeding intolerance, gut hypoperfusion secondary to low cardiac output and heart failure, hypoxemia, or ductal dependent blood supply. Nutrition intervention, with close tolerance monitoring, is safe, optimizes nutrition status, and reduces morbidity and mortality.

Keywords

Breast-feed Calorie Chylothorax Energy Energy expenditure Enteral nutrition Enteral nutrition algorithm Extracorporeal membrane oxygenation Failure to thrive Feeding Feeding tube Malabsorption Malnutrition Necrotizing enterocolitis Nutrition assessment Parenteral nutrition 

References

  1. 1.
    Cameron JW, Rosenthal A, Olson AD (1995) Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med 149(10):1098–1102CrossRefPubMedGoogle Scholar
  2. 2.
    Mitchell IM et al (1995) Nutritional status of children with congenital heart disease. Br Heart J 73:277–283CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Okoromah CAN et al (2011) Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case–control observational study. Arch Dis Child 96:354–360CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Vaidyanathan B et al (2008) Malnutrition in children with congenital heart disease (CHD) determinants and short term impact of corrective intervention. Indian Pediatr 45:541–546PubMedGoogle Scholar
  5. 5.
    Vaidyanathan B et al (2009) What determines nutritional recovery in malnourished children after correction of congenital heart defects? Pediatrics 124:e294–e299CrossRefPubMedGoogle Scholar
  6. 6.
    Varan B, Yilmaz G (1999) Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 81:49–52CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Jacobs JP, Wernovsky G, Elliott MJ (2007) Analysis of outcomes for congenital cardiac disease: can we do better? Cardiol Young 17(Suppl 2):145–158CrossRefPubMedGoogle Scholar
  8. 8.
    Tchervenkov CI et al (2008) The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young 18(Suppl 2):63–69CrossRefPubMedGoogle Scholar
  9. 9.
    Grantham-McGregor SM, Walker SP, Chang S (2000) Nutritional deficiencies and later behavioural development. Proc Nutr Soc 59(1):47–54CrossRefPubMedGoogle Scholar
  10. 10.
    Sables-Baus S et al (2011) Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery. Cardiol Young 2:1–7Google Scholar
  11. 11.
    Menon G, Poskit EM (1985) Why does congenital heart disease to thrive? Arch Dis Child 60:1134–1139CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Boctor DL, Pillo-Blocka F, McCrindle BW (1999) Nutrition after cardiac surgery for infants with congenital heart disease. Nutr Clin Pract 14(3):111–115CrossRefGoogle Scholar
  13. 13.
    FAO (2001) Human energy requirements. Energy requirements of infants from birth to 12 months 2001 [cited 2011]. Available from http://www.fao.org/docrep/007/y5686e/y5686e00.htm. Accessed on Dec 2011
  14. 14.
    Ackerman IL et al (1998) Total but not resting energy expenditure is increased in infants with ventricular septal defects. Pediatrics 102:1172–1177CrossRefPubMedGoogle Scholar
  15. 15.
    El-Sisi A et al (2009) Linear growth in relation to the circulating concentration of insulin-like growth factor-I and free thyroxine in infants and children with congenital cyanotic heart disease before vs. after surgical intervention. J Trop Pediatr 55:302–306CrossRefPubMedGoogle Scholar
  16. 16.
    Farrell AG et al (2001) Large left-to-right shunts and congestive heart with ventricular septal defect. J Cardiol 87:1128–1131CrossRefGoogle Scholar
  17. 17.
    Schwarz SM et al (1990) Enteral nutrition in infants with congenital heart disease and growth failure. Pediatrics 86:368–373PubMedGoogle Scholar
  18. 18.
    Strangway A et al (1976) Diet and growth in congenital heart disease. Pediatrics 57(1):75–86PubMedGoogle Scholar
  19. 19.
    Baum D et al (1980) Early heart failure as a cause of growth and tissue disorders in children with congenital heart disease. Circulation 62(6):1145–1151CrossRefPubMedGoogle Scholar
  20. 20.
    Sondheimer JM, Hamilton JR (1978) Intestinal function in infants with severe congenital heart disease. J Pediatr 92(4):572–578CrossRefPubMedGoogle Scholar
  21. 21.
    Van Der Kuip M et al (2003) Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr 92:921–927CrossRefPubMedGoogle Scholar
  22. 22.
    Krauss AN, Auld PA (1975) Metabolic rate of neonates with congenital heart disease. Arch Dis Child 50:539–541CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lees MH et al (1965) Relative hypermetabolism in infants with congenital heart disease and undernutrition. Pediatrics 36:183–191PubMedGoogle Scholar
  24. 24.
    Leitch CA (2000) Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol 11:195–202CrossRefPubMedGoogle Scholar
  25. 25.
    Leitch CA et al (1998) Increased energy expenditure in infants with cyanotic congenital heart disease. J Pediatr 133:755–760CrossRefPubMedGoogle Scholar
  26. 26.
    Nydegger A et al (2009) Changes in resting energy expenditure in children with congenital heart disease. Eur J Clin Nutr 63:392–397CrossRefPubMedGoogle Scholar
  27. 27.
    Jones RV (1961) Fat-malabsorption in congestive cardiac failure. Br Med J 1:1276–1278CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Vaisman N (1994) Malabsorption in infants with congenital heart disease under diuretic treatment. Pediatr Res 36:545CrossRefPubMedGoogle Scholar
  29. 29.
    Grossman H et al. (2012) The Dietary Chloride Deficiency Syndrome. Pediatrics 66(3):366–374Google Scholar
  30. 30.
    Chudley AE et al (1980) Nutritional rickets in 2 very low birthweight infants with chronic lung disease. Arch Dis Child 55:687–690CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Davis D et al (2008) Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 29:328–333CrossRefPubMedGoogle Scholar
  32. 32.
    Li J et al (2008) Energy expenditure and caloric and protein intake in infants following the Norwood procedure. Pediatr Crit Care Med: J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 9:55–61CrossRefGoogle Scholar
  33. 33.
    Kelleher DK et al (2006) Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition (Burbank, Los Angeles County, Calif) 22:237–244CrossRefGoogle Scholar
  34. 34.
    Medoff-Cooper B et al (2011) Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge. Cardiol Young 21:136–144CrossRefPubMedGoogle Scholar
  35. 35.
    Anderson JB et al (2010) Predictors of poor weight gain in infants with a single ventricle. J Pediatr 157:407–413, 413.e1CrossRefPubMedGoogle Scholar
  36. 36.
    Howley LW et al (2011) Enteral feeding in neonates with prostaglandin-dependent congenital cardiac disease: international survey on current trends and variations in practice. Cardiol Young 22:1–7Google Scholar
  37. 37.
    Natarajan G, Reddy Anne S, Aggarwal S (2010) Enteral feeding of neonates with congenital heart disease. Neonatology 98:330–336CrossRefPubMedGoogle Scholar
  38. 38.
    Willis L et al (2009) Enteral feeding in prostaglandin-dependent neonates: is it a safe practice? J Pediatr 153:867–869CrossRefGoogle Scholar
  39. 39.
    Braudis NJ et al (2009) Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation. Pediatr Crit Care Med: J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 10:460–466CrossRefGoogle Scholar
  40. 40.
    del Castillo SL et al (2010) Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol. Pediatr Crit Care Med: J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 11:373–377Google Scholar
  41. 41.
    Petrillo-Albarano T et al (2006) Use of a feeding protocol to improve nutritional support through early aggressive enteral nutrition in the pediatric intensive care unit. Pediatr Crit Care Med: J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 7:340–344CrossRefGoogle Scholar
  42. 42.
    De Wit B et al (2010) Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease. Pediatr Crit Care Med 11:496–501PubMedGoogle Scholar
  43. 43.
    Kogon BE (2007) Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis 2:332–337CrossRefPubMedGoogle Scholar
  44. 44.
    Shew S et al (1999) The determinants of protein catabolism in neonates on extracorporeal membrane oxygenation. J Pediatr Surg 34:1086–1090CrossRefPubMedGoogle Scholar
  45. 45.
    Keshen TH et al (1997) Stable isotopic quantitation of protein metabolism and energy expenditure in neonates on- and post-extracorporeal life support. J Pediatr Surg 32(7):958–962, discussion 962–3CrossRefPubMedGoogle Scholar
  46. 46.
    Jaksic T et al (2001) Do critically ill surgical neonates have increased energy expenditure? J Pediatr Surg 36:63–67CrossRefPubMedGoogle Scholar
  47. 47.
    Shew SB et al (1999) The determinants of protein catabolism in neonates on extracorporeal membrane oxygenation. J Pediatr Surg 34(7):1086–1090CrossRefPubMedGoogle Scholar
  48. 48.
    Hanekamp MN et al (2005) Routine enteral nutrition in neonates on extracorporeal membrane oxygenation. Pediatr Crit Care Med: J Soc Crit Care Med World Fed Pediatr Intensiv Crit Care Soc 6:275–279CrossRefGoogle Scholar
  49. 49.
    Hanekamp MN et al (2005) Gut hormone profiles in critically ill neonates on extracorporeal membrane oxygenation. J Pediatr Gastroenterol Nutr 40:175–179CrossRefPubMedGoogle Scholar
  50. 50.
    Wertheim HF et al (2001) The incidence of septic complications in newborns on extracorporeal membrane oxygenation is not affected by feeding route. J Pediatr Surg 36:1485–1489CrossRefPubMedGoogle Scholar
  51. 51.
    Piena BM, Gischler S, Tibboel D (1998) Introduction of enteral feeding in neonates on ECMO after evaluation of intestinal permeability changes. J Pediatr 33:30–34Google Scholar
  52. 52.
    Mehta NM, Compher C (2009) A.S.P.E.N. clinical guidelines: nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr 33(3):260–276CrossRefPubMedGoogle Scholar
  53. 53.
    Mehta NM et al (2009) Cumulative energy imbalance in the pediatric intensive care unit: role of targeted indirect calorimetry. JPEN J Parenter Enteral Nutr 33(3):336–344CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Vazquez Martinez JL et al (2004) Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period. Pediatr Crit Care Med 5(1):19–27CrossRefPubMedGoogle Scholar
  55. 55.
    Klapps P et al (1992) Endocrine function in multiple sclerosis. Acta Neurol Scand 85(5):353–357CrossRefPubMedGoogle Scholar
  56. 56.
    Hulst JM et al (2004) The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. Clin Nutr 23(6):1381–1389CrossRefPubMedGoogle Scholar
  57. 57.
    Klein CJ, Stanek GS, Wiles CE 3rd (1998) Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 98(7):795–806CrossRefPubMedGoogle Scholar
  58. 58.
    Haugen HA, Chan LN, Li F (2007) Indirect calorimetry: a practical guide for clinicians. Nutr Clin Pract 22(4):377–388CrossRefPubMedGoogle Scholar
  59. 59.
    Branson RD, Johannigman JA (2004) The measurement of energy expenditure. Nutr Clin Pract 19(6):622–636CrossRefPubMedGoogle Scholar
  60. 60.
    Einarson KD, Arthur HM (2003) Predictors of oral feeding difficulty in cardiac surgical infants. Pediatr Nurs 29(4):315–319PubMedGoogle Scholar
  61. 61.
    Hofner G et al (2000) Enteral nutrition support by percutaneous endoscopid gastrostomy in children with congeintal heart disease. Pediatr Cardiol 21:341–346CrossRefPubMedGoogle Scholar
  62. 62.
    Wylie MC et al (2010) Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol 31(10):1049–1056CrossRefPubMedGoogle Scholar
  63. 63.
    WHO (2006) WHO Child Growth Standards. [cited 2010]. Available from http://www.who.int/childgrowth/standards/technical_report/en/index.html. Accessed on Oct 2011
  64. 64.
    Grummer-Strawn LM, Reinold C, Krebs NF (2010) Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. Centers for Disease Control and Prevention, 1–18Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of Clinical NutritionChildren’s Hospital Colorado B270AuroraUSA
  2. 2.Section of Nutrition, Department of PediatricsUniversity of Colorado School of MedicineAuroraUSA

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