Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Congenital heart disease · Reflux · Growth ·

Nutrition · Lactation consultation · Breastfeeding

Key Messages

• Assess and maximize growth promotion in every
  encounter/visit


• Utilize breast milk if available and tolerated


• Encourage breastfeeding/nonnutritive sucking if
  safe


• Treat clinical symptoms of reflux, constipation and
  formula/milk intolerance


• Close communication concerning goals of growth
  and development © 2015 S. Karger AG, Basel

Introduction

Congenital heart disease (CHD) and its impact on
infant growth and development has been well doc-
umented in the literature over the years. The most
risky cardiac lesions are cyanotic CHD lesions, and
they are outlined in table 1. The goal of this chapter
is to focus on those infants with single-ventricle
physiology at high risk for growth failure, such as
double outlet right ventricle, tricuspid atresia and
hypoplastic left heart syndrome, who have under-
gone stage 1 palliation (Norwood or Sano proce-
dure). Practical guidance will be provided to those
practitioners caring for fragile and at-risk neonates

between stage 1 and stage 2 palliation (Glenn pro-

cedure). However, the principles outlined can be

applied to other conditions associated with poor

growth listed in table 1.

Outlined here are key concepts essential for

optimizing growth; they include the following:

utilization of breast milk; lactation consultation;

practical caloric density increases; hands-on rec-

ipe education; and promotion of normal growth

and development. Speech and otolaryngology

involvement in the care team is also key to pro-

moting optimal growth and developmental

milestones. Equally important is acknowledging

ref lux, constipation, and milk and protein intol-

erance, and treating these issues early, as they are

essential to optimal growth success. Figure 1

demonstrates the complexity of the many com-

mon growth variables interacting in CHD.

Impact of Home Surveillance Program on

Nutrition and CHD

With the advent of home surveillance in 2000 [1] ,

postnatal attention to nutrition following dis-

charge from stage 1 palliation has become height-

ened and a main center of focus until stage 2 pal-

liation, typically at 3–6 months of age [2–5]. In

2003 the first multicenter quality improvement

collaborative within the USA, the Joint Council

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 250–253
DOI: 10.1159/000360346

3.20 Heart Disease

Michelle M. Steltzer  Terra Lafranchi