Improving nutrition in pediatric heart failure.

Heart failure occurs in 0.9 to 3 per 100,000 children, and can be the result of either structural heart disease, genetic, or acquired cardiomyopathies. Malnutrition remains a major concern in this population, and results from the complex interplay between decreased dietary intake, decreased absorption, and an altered metabolic state. Assessing nutritional status remains a challenge, with conventional anthropometric measures often being unsuitable. To this end, the Subjective Global Nutrition Assessment has been developed and this, in combination with indirect calorimetry, can be used to give a better estimate of a child's nutritional status and caloric needs. Determining the best way to meet these needs requires a multidisciplinary team approach, determining both the most appropriate feeding route and most appropriate type of feed. This is particularly important with the trend toward blended feeds, as these feeds must not only meet protein-energy requirements but must also not exceed daily sodium requirements or fluid restrictions. To further optimize heart failure through nutrition, the use of micronutrient supplementation has evolved. In particular, optimizing vitamin D, selenium, and iron has been shown to be beneficial from a heart failure management perspective. As nutrition plays such a vital role in the medical optimization of pediatric patients with heart failure, it is important to acknowledge the impact this can have on the child and the family unit.