A characteristic
feeding pattern of children with CHD is
defined, with a large variation in caloric intake.1
When heart failure is mild the infant commonly
overfeeds, and fluid and sodium overload
disturb cardiac haemodynamics, leading
to decompensation of heart failure and decreased
intake. As a result, the individual’s
overall nutrient intake is inadequate. Arterial
blood gas analysis of patients with congestive
heart failure commonly reveals normal values,
but a form of “stagnant anoxia” caused by
sluggish capillary blood flow within the tissues,
which leads to cellular hypoxia, occurs in congestive
heart failure.4Anorexia also accompanies
malnutrition and further compromises the
patient’s condition. Dyspnoea and tachypnoea
in patients with congestive heart failure lead to
propensity for fatigue and decreased intake.
Chronic hypoxia is reported to aVect growth.
Hypoxic hypoxia has been shown to cause anorexia
in experimental rats, along with a
concomitant decrease in body weight.9 Chronic
hypoxia may contribute to the feeding problem
in cardiac patients. Malabsorption is also
thought to play a role in cardiac cachexia.4 It
can result from both congestive heart failure
and oxygen lack. We did not investigate occurrence
of malabsorption in our patients. Children
with CHD are known to be in a
hypermetabolic state.10 Heart disease causes an
increase in cardiac and respiratory work.
Decreased intake caused by anorexia combined
with increased respiratory eVort results
in a greater nutrient deficit. Children with
heart disease may need as much as 50% more
calories than normal children in order to
achieve normal growth.1 A combination of
these factors predisposes the infant to malnutrition
and growth failure