Nutrition and growth in congenital heart disease

Abstract

Optimizing nutritional intake has been targeted as a key component of the National Pediatric Cardiology Quality Improvement Collaborative. This initiative has enabled the development of best practices that have the potential to mitigate poor growth in children with congenital heart defects.

Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan

“…Since 95% of the world’s malnourished live in low/middle-income countries,24 congenital heart programmes in resource-limited settings must recognise the impact malnutrition can have on the programme’s outcomes. Optimisation of nutritional intervention before and after surgical correction and standardisation of feeding protocols is vital to achieve the best postoperative care 25. Nurses empowered through the IQIC programme have initiated a nutritional intervention quality improvement initiative following the identification of this risk factor.…”

Identification and Management of Acute Malnutrition in Hospitalized Children

“…A European multicenter study in 12 countries reported 7% of the hospitalized children were malnourished upon admission (7). In this and other surveys, rates of malnutrition are higher in association with specific disease conditions including psychiatric disorders, gastrointestinal disease, congenital heart disease, among others (3,7). Notably, many and sometimes most hospitalized malnourished children do not receive nutrition support (5).…”

Improved Nutrition Delivery and Nutrition Status in Critically Ill Children With Heart Disease

“…These are complex clinical outcomes of which providing good nutrition is but 1 contributor. 7,8,10 For example, Children's Hospital Colorado's Heart Institute does not have a standardized process for gastrostomy tube placement for infants unable to meet their oral intake goals. Approximately 40% of infants with single-ventricle physiology undergo gastrostomy tube placement; and the variability in this practice is felt to greatly affect length of stay.…”

“…Poor caloric and protein delivery and inability or loss of ability to orally feed and breastfeed may contribute to neurodevelopmental and neurocognitive delays as well as to parental frustration, anxiety, and disappointment. [7][8][9][10] Lower than growth velocity than that expected for age and gender is prevalent in infants and children with congenital heart disease and may be due to inadequate nutrition delivery. [11][12][13][14][15] In infants with single-ventricle physiology, providing adequate nutrition can be particularly difficult.…”

“…[11][12][13][14][15] In infants with single-ventricle physiology, providing adequate nutrition can be particularly difficult. 8,10 For infants undergoing staged palliation, the interstage period (after S1P and before the Glenn procedure) can be particularly challenging and is a time of increased risk of mortality. 16,17 Poor growth patterns can negatively affect both short-and longer-term outcomes, including infection rates, length of stay, and neurodevelopmental and neurocognitive performance.…”