Nutritional Approach of Pediatric Patients Diagnosed with Congenital Heart Disease

Abstract

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 signifi cance 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, ineffi cient 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.

Anthropometric Profile of Children With Cyanotic and Noncyanotic Congenital Heart Disease

“…Infant with complex CHD suff ered from failure to grow is well documented include presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. The etiology of malnutrition etiology can be grouped into: inadequate intake, ineffi cient absorption and utilization, and/or increased energy needs (Rodica 2013). The diff erence growth disorders in patients with CHD compared with healthy children can be attributed to diff erences in the factors, including gender, age, cardiac abnormalities, simultaneous multiple congenital heart defects, and congestive heart failure (Noori et al, 2017).…”

Profile of Acyanotic Congenital Heart Defect in Children at Dr. Soetomo General Hospital Surabaya Period of January – December 2016

“…7 Other than that, symptoms experienced by children with congestive heart failure such as dyspnea and tachypnea that appear during eating cause children to feel tired, loss of appetite, and lead to a decrease in the quantity of food consumed by children. 8 Decrease of ghrelin in blood is also noted in acyanotic congenital heart defect patients. 6 Ghrelin causes inhibition of leptin, so it can be concluded that if there is a decrease in ghrelin levels, it can be predicted there will be an increase in leptin levels in blood.…”

“…7 There was also an association between chronic hypoxemia and endocrine function in patients with congenital heart defect. 8 Chronic hypoxemia can cause a decrease in IGF-1 levels in the blood, a peptide that plays in important role in growth, so that the growth of body tissue cannot be achieved optimally. 8 Although chronic hypoxemia is more common in cyanotic congenital heart defect compared to acyanotic, this mechanism still can be one of the causes of failure to thrive in children with acyanotic congenital heart defect.…”

“…8 Chronic hypoxemia can cause a decrease in IGF-1 levels in the blood, a peptide that plays in important role in growth, so that the growth of body tissue cannot be achieved optimally. 8 Although chronic hypoxemia is more common in cyanotic congenital heart defect compared to acyanotic, this mechanism still can be one of the causes of failure to thrive in children with acyanotic congenital heart defect. 8 Growth pattern in acyanotic congenital heart defect patients influenced by several factors such as type of congenital heart defect, presence of gastrointestinal disorder, and presence of chromosomal abnormalities.…”

“…8 Although chronic hypoxemia is more common in cyanotic congenital heart defect compared to acyanotic, this mechanism still can be one of the causes of failure to thrive in children with acyanotic congenital heart defect. 8 Growth pattern in acyanotic congenital heart defect patients influenced by several factors such as type of congenital heart defect, presence of gastrointestinal disorder, and presence of chromosomal abnormalities. 6 The degree of failure to thrive in children is directly proportional to the size of the shunt, therefore children with congenital heart defect without a shunt may show normal pattern of growth.…”