Forchielli M L, McColl R, Walker W A, Lo C
Combined Program in Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital and Children's Hospital, Boston.
Nutr Rev. 1994 Oct;52(10):348-53. doi: 10.1111/j.1753-4887.1994.tb01359.x.
Growth in children with congenital heart disease (CHD) is often compromised. For several decades, investigators have tried to identify the factors affecting growth in children with CHD. Cardiac malformations are undoubtedly responsible for malnutrition, which may range from mild undernutrition to severe failure to thrive (FTT). Malnutrition may then significantly undermine the outcome of corrective surgical operations and postoperative recovery. Mechanisms linking CHD to malnutrition may be related either to decreased energy intake and/or to increased energy requirements. Decreased energy intake can involve deficiencies of specific nutrients, or insufficient total caloric intake. Increased respiratory rate accompanying congestive heart failure may be responsible for increased energy requirements. Different types of cardiac malformations and consequent interventions may have different effects on growth and require diverse strategies. Most treatment strategies aim to facilitate "catch-up" growth, providing extra calories and protein that exceed the Recommended Dietary Allowance for age. However, there is no generally accepted set of guidelines that define appropriate caloric intake for catch-up growth. We attempt to identify the most important causes of malnutrition and highlight the most effective nutrition strategies for children with CHD.
先天性心脏病（CHD）患儿的生长发育常常受到影响。几十年来，研究人员一直试图找出影响CHD患儿生长的因素。心脏畸形无疑是导致营养不良的原因，营养不良的程度可能从轻度营养不足到严重发育迟缓（FTT）不等。营养不良进而可能严重影响矫正手术的效果和术后恢复。将CHD与营养不良联系起来的机制可能与能量摄入减少和/或能量需求增加有关。能量摄入减少可能涉及特定营养素的缺乏，或总热量摄入不足。充血性心力衰竭伴随的呼吸频率增加可能导致能量需求增加。不同类型的心脏畸形及相应的干预措施可能对生长有不同影响，需要采取不同策略。大多数治疗策略旨在促进“追赶”生长，提供超过年龄推荐膳食摄入量的额外热量和蛋白质。然而，对于追赶生长时适当的热量摄入，尚无一套普遍接受的指导原则。我们试图找出营养不良的最重要原因，并强调针对CHD患儿最有效的营养策略。
