Growth failure and nutritional-endocrine adaptations in children with cyanotic CHD: a structured narrative review

The heart is increasingly recognised as a cardiovascular signalling organ that releases biologically active natriuretic peptides during haemodynamic stress. In cyanotic CHD, chronic hypoxaemia, altered loading conditions, increased energy expenditure, recurrent illness, and delayed repair may disrupt endocrine, metabolic, and nutritional pathways that regulate growth. This structured narrative review synthesises evidence linking cardiac biomarkers, systemic hormonal adaptation, nutritional status, surgical timing, and growth outcomes in children with cyanotic CHD. PubMed, Scopus, and Google Scholar were searched for human studies published from January 1990 to December 2025 that reported cardiac biomarkers, systemic hormonal measures, growth parameters, nutritional outcomes, or postoperative recovery in paediatric CHD. Thirty-six studies were included and narratively synthesised because lesion types, age groups, assays, and outcomes were heterogeneous. The evidence indicates consistent activation of natriuretic peptide signalling, reduced circulating insulin-like growth factor 1 and insulin-like growth factor binding protein 3 in several paediatric cohorts, appetite-related hormonal changes, impaired weight gain, and frequent linear growth faltering. Longitudinal studies suggest partial improvement in growth velocity and anabolic signalling after timely surgical correction, although incomplete recovery may occur when preoperative hypoxaemia and undernutrition are prolonged. Growth failure in cyanotic CHD should therefore be regarded as a multifactorial cardiovascular-nutritional syndrome rather than isolated primary endocrine disease. Early surgical referral, individualised nutrition, and coordinated cardiology, endocrinology, and dietetic follow-up are central to improving long-term outcomes.