Medical Nutrition Therapy in Heart Failure Paediatric

Nur Hidayah G1, Norul Huda I2
1. Centre Of Nutrition and Dietetic, Faculty of Health Sciences, Universiti Teknologi MARA UiTM,  2. Dept. of Dietetic and Food Service, Hospital Tengku Ampuan Rahimah, Selangor.

Assessment: A 5 months old Malay boy was diagnosed with large perimembraneous ventricular septal defect (PMVSD) and moderate arterial septal defect (ASD) with pneumonia. Patient presented with severe respiratory distress required highest ventilator support before wean down to duo-positive airway pressure. Chest x-ray and echocardiography done and shown cardiomegaly and heart failure. He was further referred to paediatric cardiologist and aim for operation when body weight increase at satisfied range. Patient born term with birth weight 3.125kg. Admission weight and length were 5.1 kg and 59.5cm which both were below 3rd percentile. His ideal body weight was 7.7kg and length 66cm at 50th percentile based on weight-for-age and length-for-age of WHO growth charts. His biochemical data shown normal as well as vital sign. Patient was on Ryles tube feeding with fluid restricted 60ml/3 hourly providing 69kcal/kg/day and 1.6g/kg/day of protein. Anti-failure medications started which were intravenous Frusemide, Spironolactone and Captopril as well as Ceftriaxone to treat pneumonia infection. Energy and protein requirement were153kcal/kg/day and 3.1g/kg/day based on catch-up growth formula (Peterson, 1984).

Diagnosis: Growth rate below expected related to the physiological impetus for increase nutrients needs (heart failure) as evidenced by weight-for-age and length-for-age were

Intervention: Main goal was to provide adequate energy and protein in order to increase body weight before proceeds to cardiac assessment. Patient was given standard formula milk with adding glucose polymer and slowly increases the volume in each feed until reach 75ml/3 hourly which provide 130kcal/kg/day and 2.5g/kg/day.

Monitoring and Evaluation: Patient tolerate well with feeding regime planned and body weight increase gradually from 5.07kg until 5.43 kg. The prevalence of malnutrition, underweight and stunting is high in children with heart disease. Appropriate nutrition intervention is vital in order to improve clinical outcomes and quality of life overall.