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Growth, nutrition and energy expenditure in pediatric heart failure
1Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University Medical Center, Indianapolis, IN, USA
Insights
Congenital heart disease (CHD) in children elevates energy expenditure, leading to inadequate energy for growth despite sufficient caloric intake. Understanding metabolic needs is crucial for nutritional support and reducing failure to thrive.
Area of Science:
- Pediatric Cardiology
- Developmental Biology
- Nutritional Science
Background:
- Growth disturbances are common in infants and children with congenital heart disease (CHD).
- The severity of growth issues correlates with the anatomical defect, being most pronounced in those with congestive heart failure.
- Surgical repair is often postponed to allow for weight gain, with surgery performed at an ideal weight/age or when failure to thrive necessitates intervention.
Purpose of the Study:
- To investigate the energy balance in infants and children suffering from congenital heart disease.
- To determine if caloric intake is sufficient for normal growth given elevated energy expenditure.
- To highlight the need for more data on metabolic requirements in specific pediatric CHD populations, particularly those with congestive heart failure.
Main Methods:
- Analysis of existing data on caloric intake and energy expenditure in pediatric patients with CHD.
- Comparison of energy expenditure in CHD patients versus age-matched healthy controls.
- Identification of knowledge gaps regarding specific patient populations and their metabolic needs.
Main Results:
- Caloric intake may appear adequate for age but is insufficient to support normal growth rates in children with CHD.
- Energy expenditure is significantly elevated in infants and children with CHD compared to healthy peers.
- The combination of adequate intake and high expenditure results in limited energy availability for growth.
Conclusions:
- Infants and children with CHD have a negative energy balance for growth due to increased energy expenditure.
- Accurate prediction of metabolic needs requires further research into energy intake and expenditure in specific CHD populations.
- Improved understanding of nutritional requirements can enhance nutritional support, reduce failure to thrive, and decrease surgical risks.
Abstract:
Disturbances in growth are often a consequence of congenital heart disease during infancy and childhood. The magnitude of the growth disturbance is generally related to the anatomical lesion and is most severe in infants and children with congestive heart failure. Presently, surgical repair in this population is often delayed in order to permit increased weight gain. Surgery is preformed when a patient reaches an ideal weight and age, or failure to thrive precludes further waiting. The available data indicate that caloric intake in these infants and children may be nearly adequate for age, but is inadequate to permit normal growth rates. Energy expenditure appears to be significantly elevated in this population relative to that of age-matched infants and children. Therefore, while caloric intake may be appropriate for age, increased energy expenditure leaves the infant or child with congenital heart disease with little energy available for growth. More information is needed on energy intakes and expenditures of specific patient populations, and especially of patients with congestive heart failure, before accurate predictions of their metabolic needs are possible. This knowledge may allow us to better meet the nutritional needs of these populations and decrease the risk of malnutrition and failure to thrive, in turn decreasing surgical risk for these patients.