Feeding the child with congenital heart disease: A narrative review

Abstract

Children with congenital heart disease (CHD) are prone to nutritional challenges and undernutrition. For children with unrepaired CHD, growth is often compromised due to caloric imbalance stemming from high energy expenditure and poor nutritional intake as a result of feeding intolerance, fluid restriction, and impaired absorption. The resulting undernutrition is associated with frequent infections, poor wound healing, and increased mortality, creating strong incentives for early and aggressive nutrition intervention. Management strategies are therefore aimed at ensuring that dietary provisions meet the child's distinctive needs by prioritising human milk for infants, increasing energy delivery through higher caloric density feeds, use of enteral feeding tubes, parenteral nutrition for energy supplementation, and medical therapy to treat feeding intolerance. The perioperative period also presents unique challenges and opportunities for nutritional support, including early introduction of enteral nutrition to support improved postoperative recovery and ensuring feeding delivery meets the child's energy and protein requirements to avoid a catabolic state. Indirect calorimetry can be utilized to measure energy consumption and avoid under or over nutrition. Specific nutritional approaches affecting the CHD population are also required, such as chylothorax or protein-losing enteropathy, to provide adequate nutritional support without contributing to harm. This narrative review describes the nutritional considerations, obstacles and complications faced by children with CHD across their different phases of care, and the treatment approaches aimed to mitigate a negative impact.