Nutritional Approach of Pediatric Patients Diagnosed with Congenital Heart Disease

Open access


Congenital heart defects are among the most frequent anomalies present at birth, representing a heterogeneous group of malformations, both in terms of pathogenesis and clinical significance of the lesion. Failure to grow is well documented in infants with complex congenital heart defects; the presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. Malnutrition etiology can be grouped into the following three categories: inadequate intake, inefficient absorption and utilization, and/or increased energy needs. The consequences of malnutrition are both short and long term, timely nutritional intervention being necessary in order to maintain an adequate nutritional state. Because there are several types of congenital heart defects and multiple mechanisms by which they produce failure to thrive, no single strategy will be adequate to treat all cases. Medical complications such as chylotorax, necrotizing enterocolitis, laryngeal and neurological dysfunction play a major role in the requisite nutrition therapy in infants with congenital heart defect; limited access to human milk and parenteral concerns, as well as stress about feeding are also factors that can contribute to poor outcomes concerning nutrition and growth. Protocols are being considered and designed, and a systematic approach is always needed. The quality of life for patient and family, as well as getting the child back on track for age-appropriate development are always at the fore-front of each care plan.

1. Mitchell SC, Korones SB. Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history, Circulation. 1971;43:323-332.

2. Schultz AH, Localio AR, Clark BJ, et al. Epidemiologic features of the presentation of critical congenital heart disease: Implantations for Screening. Pediatrics. 2008;121:751-757.

3. Norris MK, Hill CS. Nutritional issues in infants and children with congenital heart disease. Crit Care Nurs Clin North Am.1994;6:153-163.

4. Leitch CA. Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol. 2000;11:195-202.

5. Peterson RW, Wetzel GT. Growth failure in congenital heart disease: where are we now? Curr Opin Cardiol. 2004;19:81-83.

6. Medoff-Cooper B, Irving Sh. Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiology in the Young. 2009;19(suppl. 2):90-95.

7. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child. 1999;81(1):49-52.

8. Hansen SR, Dorup I. Energy and nutrient intakes in congenital heart disease. Acta Paediatr. 1993;82(2):166-72.

9. Leitch CA. Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol. 2000;11(3):195-202.

10. Poskitt EM. Failure to thrive in congenital heart disease. Arch Dis Child. 1993;68(2):158-60.

11. Ackerman IL, Karn CA, Denne SC, Ensing GJ, Leitch CA. Total but not resting energy expenditure is increased in infants with ventricular septal defects. Pediatrics. 1998;102(5):1172-7.

12. Menon G, Poskitt EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child. 1985;60(12):1134-9.

13. Leitch CA. Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol. 2000;11:195-202.

14. Poskitt EM. Food, growth and congenital heart disease. Nutr Health. 1987;5:153-161.

15. Anderson JB. Kalkwarf HJ, Kehl JE, et al. Low weight-for-age z score and infection risk after the Fontan procedure. Ann Thorac Surg. 2011;91:1460-1466.

16. Parrish CR. Nourishing little hearts: nutritiional implications for congenital heart defects. Practical Gastroenterology. 2011;11-34

17. Ehlers KH. Growth failure in association with congenital heart disease. Pediatr Ann. 1978;7:750-759.

18. Vaidyanathan B, Kumar RK. What Determines Nutritional Recovery in Malnourished Children After Correction of Congenital Heart Defects? Pediatrics. 2009;124(2):e294.

19. Unger R, DeKleermaeker M, Gidding SS, Christoffel KK. Calories count. Improved weight gain with dietary intervention in congenital heart disease. Am J Dis Child. 1992;146(9):1078-84.

20. Jackson M, Poskitt EM. The effects of high-energy feeding on energy balance and growth in infants with congenital heart disease and failure to thrive. Br J Nutr. 1991;65(2):131-43.

21. Bougle D, Iselin M, Kahyat A, Duhamel JF. Nutritional treatment of congenital heart disease. Arch Dis Child. 1986;61(8):799-801.

22. Hofner G, Behrens R, Koch A, Singer H, Hofbeck M. Enteral nutritional support by percutaneous endoscopic gastrostomy in children with congenital heart disease. Pediatr Cardiol. 2000;21(4):341-6.

23. Marino BL, O'Brien P, LoRe H. Oxygen saturations during breast and bottle feedings in infants with congenital heart disease. J Pediatr Nurs. 1995;10(6):360-4.

24. Mitchell IM, Davies PS, Day JM, Pollock JC, Jamieson MP. Energy expenditure in children with congenital heart disease, before and after cardiac surgery. J Thorac Cardiovasc Surg. 1994;107(2):374-80.

25. Forchielli ML, McColl R, Walker WA, et al. Children with congenital heart disease: a nutrition challenge. Nutr Rev.1994;52:348-353.

26. Owens JL, Musa N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract. 2009;24:242-249.

27. Hagau N, Culcitchi C. Nutritional support in children with congenital heart disease. Nutr Ther Metab. 2010;28:172-184.

28. Medoff-Cooper B, Naim M, Torowicz D, et al. Feeding, growth, and nutrition in children with congenitally malformed hearts. Cardiol Young. 2010;20 Suppl3:149-153.

29. Giannone PJ, Luce WA, Nankervis CA, et al. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci. 2008;82:341-347.

30. Cabrera AG, Prodhanb P, Bhuttab AT. Nutritional challenges and outcomes after surgery for congenital heart disease. Curr Opin Cardiol. 2010;25:88-94.

31. Sachdeva R, Hussain E, Moss MM, et al. Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery. J Pediatr. 2007;151:312-315.

32. Skinner ML, Halstead LA, Rubinstein CS, et al. Laryngopharyngeal dysfunction after the Norwood procedure. J Thorac Cardiovasc Surg. 2005;130:1293-1301.

33. Lessen R. Use of skim breast milk for an infant with chylothorax. Infant, Child, and Adolescent Nutrition. 2009;1:303-310.

34. McCray S, Parrish CR. When chyle leaks: nutrition management options. Practical Gastroenterology. 2004;28:60.

35. Li S, Krawczeski CD, Zappitelli M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39:1493-1499.

36. Mertens L, Hagler D, Sommerville J, et al. Protein losing enteropathy after the Fontan operation: an international multicenter evaluation. J Thorac and Cardiovasc Surg. 1998;115:1063-73.

37. Meadows J, Jenkins K. Protein-losing enteropathy: integrating a new disease paradigm into recommendations for prevention and treatment. Cardiol in the Young. 2011;21:363-367.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

Journal Information

Cited By


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 448 448 42
PDF Downloads 233 233 22