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Children with congenital heart disease: a nutrition challenge
M L Forchielli1, R McColl, W A Walker
1Combined Program in Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital and Children's Hospital, Boston.
Insights
Growth in children with congenital heart disease (CHD) is often poor due to malnutrition. This study identifies key causes of poor growth and effective nutrition strategies for improving outcomes in these children.
Area of Science:
- Pediatric Cardiology
- Nutritional Science
- Growth and Development
Background:
- Congenital heart disease (CHD) frequently impairs growth in children.
- Malnutrition, ranging from undernutrition to failure to thrive (FTT), is a common complication of CHD.
- Malnutrition can negatively impact surgical outcomes and recovery in children with CHD.
Purpose of the Study:
- To identify primary causes of malnutrition in children with CHD.
- To highlight effective nutritional strategies for promoting catch-up growth.
- To address the lack of standardized guidelines for caloric intake in CHD patients.
Main Methods:
- Review of existing literature on CHD and growth.
- Analysis of factors contributing to decreased energy intake (nutrient deficiencies, insufficient calories).
- Examination of factors increasing energy requirements (e.g., increased respiratory rate in heart failure).
Main Results:
- Cardiac malformations are a direct cause of malnutrition in CHD.
- Both reduced energy intake and increased energy expenditure contribute to growth failure.
- Current strategies often involve exceeding Recommended Dietary Allowances for calories and protein.
Conclusions:
- Understanding the specific mechanisms of malnutrition in CHD is crucial.
- Tailored nutrition strategies are essential for optimizing growth and surgical outcomes.
- Further research is needed to establish evidence-based guidelines for nutritional support in CHD.
Abstract:
Growth in children with congenital heart disease (CHD) is often compromised. For several decades, investigators have tried to identify the factors affecting growth in children with CHD. Cardiac malformations are undoubtedly responsible for malnutrition, which may range from mild undernutrition to severe failure to thrive (FTT). Malnutrition may then significantly undermine the outcome of corrective surgical operations and postoperative recovery. Mechanisms linking CHD to malnutrition may be related either to decreased energy intake and/or to increased energy requirements. Decreased energy intake can involve deficiencies of specific nutrients, or insufficient total caloric intake. Increased respiratory rate accompanying congestive heart failure may be responsible for increased energy requirements. Different types of cardiac malformations and consequent interventions may have different effects on growth and require diverse strategies. Most treatment strategies aim to facilitate "catch-up" growth, providing extra calories and protein that exceed the Recommended Dietary Allowance for age. However, there is no generally accepted set of guidelines that define appropriate caloric intake for catch-up growth. We attempt to identify the most important causes of malnutrition and highlight the most effective nutrition strategies for children with CHD.