Nutrition and metabolism in the critically ill child with cardiac disease

Nutrition is a vital consideration in children with critical heart disease for several reasons: (1) nutritional deficiency may cause heart disease; (2) congenital heart disease (CHD) may cause malnutrition and poor growth, which can delay or complicate corrective surgery; (3) and congenital heart surgery may be associated with complications that lead to life-threatening metabolic and nutritional derangements. Children with CHD frequently are malnourished before surgical intervention; however, emerging evidence suggests safety and tolerance of preoperative enteral nutrition. The extent of undernutrition has a significant impact on the timing of surgical interventions, as well as the perioperative outcome. Preoperative enteral nutrition is feasible in many children. Postoperative nutritional support should be instituted early and aggressively. Enteral feedings should be employed whenever possible, and parenteral nutrition should be reserved for those unable to be fed enterally. Given the significant probability of postoperative dysphagia in many children with CHD, particularly those undergoing Norwood procedures, a multidisciplinary swallowing evaluation before oral feeding may be required. Gastroesophageal reflux, protein-losing enteropathy, and persistent chylothorax are significant postoperative complications with important nutritional complications in children with CHD. A staged therapeutic approach consisting of dietary changes, medical interventions, and then invasive interventions, if needed, is successful in mitigating the nutritional complications of each of these conditions in a majority of cases.