Congenital heart defects in the pediatric population are a serious condition. Many defects require surgical intervention to correct or improve the problem. Often, there are nutrition-related implications associated with heart defects. Here is more information about how nutrition may be affected to help you understand this aspect of your child’s health.
The Link between Nutrition and Congenital Heart Defects:
- Digestion and absorption of nutrients. The major job of the human heart is to pump blood throughout the body. The blood carries nutrients and oxygen to be used for energy and to support all body functions. With a heart defect, blood circulation may be suboptimal, since the heart may not be pumping strongly or efficiently. This can result in poor blood flow to the gut, which means that the gut is not getting the nutrients and energy it needs to perform digestive functions effectively. Nutrients may not be absorbed well, which can lead to poor weight gain and general intolerance of feeds (diarrhea, reflux, delayed gastric emptying).
- Decreased energy for feeding. Related to the previous section, infants with congenital heart defects may not have the endurance and strength to take in the volume of breastmilk or formula to meet their needs. This is partly due to their body working harder to pump blood and breathe. Also, if they are not getting adequate nutrition, they will be weaker, which makes it more difficult to feed
effectively. In some cases, the child may require tube feedings and/or formulas mixed to higher calorie concentrations. The medical team will manage this to maximize nutrition for the child.
- Post-operative complications that impact feeding. After heart surgery, the recovery course varies depending on the complexity of the original heart defect and repair, and depending on the child. With more complex cases, the child may require a ventilator for a period of time after surgery. In this case, the child will receive nutrition via tube feedings, and sometimes via intravenous route. For babies that require long-term intubation, their oral feeding and swallowing skills may be decompensated. Again, the medical team will assess this and create a plan to ensure adequate nutrition while developing feeding skills after extubation.
- Fat metabolism. One specific post-operative complication that can occur is called chylothorax. Lipids, specifically triglycerides, are digested in the gut and absorbed via the lymphatic system. Because of the location of the heart surgery, there can be trauma to the lymph vessels near the lungs. In rare cases, the lymph vessels can leak, causing a build-up of chylous fluid around the lungs. This can be detected on chest x-rays and by a milky appearance of fluid in chest tube drains. One of the first treatments is to stop enteral feeds, which decreases the leakage of chyle into the lungs. Depending on the case, the child may require intravenous feeds, and/or a special enteral formula that is very low in or devoid of triglycerides. These formulas are higher in medium chain triglycerides (MCTs), because MCTs are fatty acids that are not absorbed and transported via the lymphatic system.
- Calorie, protein, and fluid needs. In general, children with heart defects require higher calorie and protein needs than standard nutrition recommendations, especially before surgery and during the recovery period. Protein requirements are high to meet the demands of tissue repair and growth. Often, overall fluid volume needs to be somewhat restricted. This helps minimize pleural and cardiac effusions (fluid around the lungs and heart) that can occur after surgery. For these reasons, special formulations are calculated by the dietitian and physician to ensure proper nutrition and to avoid further complications.
Be sure to communicate any concerns or questions regarding nutrition with your child’s medical team. For further support or ongoing nutrition needs, it is important to have periodic visits with a registered dietitian. Ask your medical team for a referral, or contact one of our pediatric dietitians at North Shore Pediatric Therapy at 877-486-4140.