Nutritional management for patients with CHD

Nutritional Insufficiency 25% CHD. Intake 76-88% RDA. Energy expenditure increased by 40% CHF , cyanotic CHD , pulmonary hypertension , obstructive lesions .

CAUSES Increase metabolic rate and energy expenditure. (20-30 % of BMR for respiratory). Decrease intake. Decrease absorption. Repeated infections. Electrolytes and metabolic disturbance.

Other Factors Socioeconomic. Low income. Level of education. Dysfunctional family dynamics. Unstable marital status Teenager parents (single parent). Substance abuse.

IUGR 5-10% of pt. CHD Chromosomal disease. Associated disease.

Management strategy Team Parents Nutritionist Pediatrician Pediatrics gastroenterologist Home care team

Conti. Structural program: Assessment Counseling Parents education Initiating program Regular follow up

Assessment of nutritional insufficiency Growth parameters. Mid arm circumference. Triceps skin fold.

Dietary recall 24 h recall. 3 days recall. Type of formula , change . Tolerance ,vomiting . Type and amount of feeding. Supplements, fortifier. Care giver.

LABS Albumin and pre albumin. CBC , iron level , Folate. Electrolytes.

Age groups < 1 year 1-3 years >3 years

Less than 1 year Breast feeding Easier to feed Less effort on baby (HR & RR) Grow better O2 sat. was higher. Immunity Expressed BM , supplements ,fortifiers

Formula Most formulas : 67 kcal / 100 ml Semilac neosure 72 kcal /100 ml Semilac PM 60/40

Semilac 24 Semilac 27 Infantrini 100 kcal/100 ml

Concentrating the feeds Glucose polymer (Polycose ,Moducal) MCT oil Pregestimil Neocate

Continuous ,12 h NG feeding (pump). PEG feeding. Home care.

1-3 years Pediasure & Resource 1:1 Fortini 1.5:1 kcal Scandy shake 2:1 kcal Fortisep

Helpful Hints for Boosting Your Child's Intake: Add extra calories to your child's diet: Make hot cereals with whole milk instead of water Add butter or margarine to cooked cereal, potatoes, bread, rice, and cooked vegetables Add dry instant milk powder to whole milk, casseroles, soups, scrambled eggs, and cereals

Add (extra) mayonnaise to sandwiches and meat salads Use jams, jellies, or honey on toast Add dried fruits to cereals, muffins, and cookies

Add extra protein to your child's diet: Adding cheese to casseroles, sandwiches, sauces, and vegetables Adding milk to soups, puddings and cereals Making Instant Breakfast with whole milk for a snack or with meals

Spreading peanut butter on crackers, bread, celery and fruits, like apples and bananas. Adding eggs/egg whites to casseroles, hamburger and meatloaf

Additional general suggestions: Always keep snacks like cheese, buttered popcorn, granola bars, and fruited yogurt handy Be sure not to give your child too much fruit juice Establish meal time rules.