1. Nutritional management for patients with CHD

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

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

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

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

6. Management strategy Team Parents Nutritionist Pediatrician
Pediatrics gastroenterologist
Home care team

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

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

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

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

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

12. 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

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

14. Semilac 24 Semilac 27
Infantrini kcal/100 ml

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

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

17. 1-3 years Pediasure & Resource 1:1 Fortini 1.5:1 kcal
Scandy shake 2:1 kcal
Fortisep

19. 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

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

21. 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

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

23. 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.