Growth, nutrition and energy expenditure in pediatric heart failure.

Disturbances in growth are often a consequence of congenital heart disease during infancy and childhood. The magnitude of the growth disturbance is generally related to the anatomical lesion and is most severe in infants and children with congestive heart failure. Presently, surgical repair in this population is often delayed in order to permit increased weight gain. Surgery is preformed when a patient reaches an ideal weight and age, or failure to thrive precludes further waiting. The available data indicate that caloric intake in these infants and children may be nearly adequate for age, but is inadequate to permit normal growth rates. Energy expenditure appears to be significantly elevated in this population relative to that of age-matched infants and children. Therefore, while caloric intake may be appropriate for age, increased energy expenditure leaves the infant or child with congenital heart disease with little energy available for growth. More information is needed on energy intakes and expenditures of specific patient populations, and especially of patients with congestive heart failure, before accurate predictions of their metabolic needs are possible. This knowledge may allow us to better meet the nutritional needs of these populations and decrease the risk of malnutrition and failure to thrive, in turn decreasing surgical risk for these patients.