Heart Disease 251
3
on CHD, was formed, and was subsequently in-
strumental in bringing parents and caregivers at
home to the table as team members [6]. The team
works in concert to optimize growth strategies for
this fragile single-ventricle physiology population
at every encounter/visit. Many lessons learned by
the Joint Council on CHD can be shared with in-
ternational centers.
Nutrition: Breast Milk, Breastfeeding and
Fortification
Breast milk has many known benefits: parental
bonding; antibodies; being easier to digest; and
often having a higher calorie content than 20-cal
formulae (65–70 kcal/100 ml). Breastfeeding also
provides oral motor and speech benefits [5]. Now
that prenatal diagnosis is more common, parents
have more time to become educated on breast
milk and breastfeeding prior to delivery. Lacta-
tion consultants should meet with families prena-
tally to discuss ways to promote and establish ear-
ly breast milk supply, pumping, early nonnutri-
tive breastfeeding and maternal diet with the
ultimate goal to maximize breastfeeding and uti-
lization of available breast milk from birth. With
CHD, the feeding process is often complex and
dependent on the medical status of the patient.
The breast milk may need to be primarily hind-
milk, fortified or even supplemented with bottle
or other enteral feeding methods, particularly
during the initial postoperative newborn period.
With the many individual confounding variables
considering patients’ medical intake [5, 7] , ideas
about sole breastfeeding in this population are in-
consistent. Opportunities to promote successful
breastfeeding during first hospitalization and the
interstage period are present. A recent case study
on a high-risk infant unable to breastfeed at time
of discharge from stage 1 palliation has shown
promise and successful transition to full breast-
feeding by the time of stage 2 palliation [8, 9].
Caloric supplementation is common in the
high-risk single-ventricle population to aid in
growth. The focus on proper education by nutri-
tionists utilizing measuring utensils is critical,Ta b l e 1. Cardiac lesions posing risks for growth delay
Acyanotic CHD lesions: weight growth disturbance^1
Aortic stenosis
Pulmonary stenosis
Coarctation of the aorta
Ventricular septal defect^2
Patent ductus arteriosus^2
Atrial septal defect^2
Atrioventricular valve regurgitation^2
Semilunar valve regurgitation (less common)^2
Cyanotic CHD lesions: weight and height
growth disturbance^3
Double outlet right ventricle
Transposition of the great arteries
Tetralogy of Fallot with or without pulmonary atresia
Tricuspid atresia
Hypoplastic left heart syndrome
(^1) If there is significant shunting and/or pulmonary hyper-
tension, height disturbances may also be noted.
(^2) Lesions prone to pulmonary overcirculation have a
greater impact on growth.
(^3) Hypoxemia length in years is thought to affect growth
retardation. Hypoxemia accompanied by congestive
heart failure has a greater impact on growth.
Nutrition: breast milk,
breastfeeding, fortification
and promotion of normal
growth and development
Constipation Anticoagulation
Milk protein
allergy
Gastroesophageal
reflux
Fig. 1. Common growth variables in CHD.
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