Optimizing Nutrition in Pediatric Heart Failure: The Crisis Is Over and Now It’s Time to Feed

Abstract

Pediatric heart failure is a complex disease occurring when cardiac output is unable to meet the metabolic demands of the body. With improved surgical interventions and medical therapies, survival rates have improved, and care has shifted from focusing on survival to optimizing quality of life and health outcomes. Based on current literature, this review addresses the nutrition needs of infants and children in heart failure and describes the pathophysiology and metabolic implications of this disease. The prevalence of wasting in pediatric heart failure has been reported to be as high as 86%, highlighting the importance of nutrition assessment through all stages of treatment to provide appropriate intake of energy, protein, and micronutrients. The etiology of malnutrition in pediatric heart failure is multifactorial and involves hypermetabolism, decreased intake, increased nutrient losses, inefficient utilization of nutrients, and malabsorption. Children in heart failure often present with tachypnea, tachycardia, fatigue, nausea, and vomiting and consequently may not be able to meet their nutrition requirements through oral intake alone. Nutrition support, including enteral nutrition and parenteral nutrition, should be considered an essential part of routine care. The involvement of multiple allied health professionals may be needed to create a feeding therapy plan to support patients and their families. With appropriate nutrition interventions, clinical outcomes and quality of life can be significantly improved.

Paediatric cardiomyopathies: echocardiographic diagnosis, clinical profile, and demographic characteristics: the experience of a tertiary referral centre for Latin American paediatric cardiology

“…47,48 The aetiology of malnutrition in paediatric heart failure is multifactorial and involves hypermetabolism, decreased intake, increased nutrient losses, inefficient utilisation of nutrients, and malabsorption. 49 The most commonly reported comorbidity in our patients was renal impairment, with a direct and strong association demonstrated between left ventricular ejection fraction and functional class, and the degree of renal compromise (14% of the patients with left ventricular ejection fraction >50% had kidney dysfunction versus 32% in those with left ventricular ejection fraction <50%). This association has been previously outlined and it highlights the importance of kidney function monitoring in these patients, as a decrease in renal function is associated with a worse prognosis.…”

The impact of home hemodialysis in children with severe cardiac failure

“…Improving nutrition is likely to be a factor that contributed to cardiac recovery. 4 Cases 1 and 3 progressed to nocturnal dialysis, but Case 2 remained on daytime treatments and subjectively her rate of cardiac recovery was slower. Nocturnal dialysis has been associated with a number of cardiovascular benefits including improved hypertension and LV mass 5 and a reduction in HD associated myocardial stunning.…”

“…Previously published case 1 presented aged 3 with a unilateral Wilms' tumor that a second tumor aged 5. She underwent bilateral nephrectomies, anthracycline chemotherapy and commenced HD, 4…”

Major Predictors of Incidence of Congestive Heart Failure and the Responsive Character of Enteral Nutrition: Meta-Analysis

“…Approximately 23 million people are carriers of this disease and two million new cases are diagnosed each year. CHF is an important public health issue due to its high prevalence, severity of clinical manifestations and reserved prognosis [ 3 , 4 ].…”

“…In recent decades, it has become clear that pathological changes involve not only the cardiovascular system, but also the renal, neuro-endocrinological, immunological, hematological, gastrointestinal and musculoskeletal systems, as well as nutritional status [ 1 - 3 , 6 , 7 ]. Currently, experimental and clinical studies have focused on the pathophysiology of systemic complications related to CHF in order to establish treatments to improve quality of life and increase survival [ 7 , 8 ].…”