title: Nutritional challenges and outcomes after surgery for congenital heart disease.
abstract: OBJECTIVE
  Adequate nutrition is crucial in children after surgery for congenital heart disease. We address selected nutritional and caloric requirements for children in the perioperative period before and after cardiac surgery and explore nutritional interdependence with other system functions. Recommendations based on our current practice are made at the end of each section.
  
  
  RESULTS
  Early identification of deficient oropharyngeal motor skills and vocal cord dysfunction is crucial to establish enteral nutrition safely and has been demonstrated to improve clinical outcomes. The use of prealbumin as a marker of nutritional state should be accompanied by C-reactive protein given the influence of inflammation on its levels. Insulin infusions may improve outcomes in patients with postoperative hyperglycemia. Trace element abnormalities and early identification of immune-compromised states can aid in reducing morbidity in children after cardiac surgery. Use of feeding protocols and a home surveillance system for hypoplastic left heart syndrome improves outcomes.
  
  
  CONCLUSIONS
  Adequate nutritional support in children after cardiac surgery is a challenge. Attention to lesion-specific feeding problems, supplementation of trace elements and minerals, and an organized approach to pace, timing, and type of feeding are beneficial.
authors.affiliation: Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, Tennessee 38103, USA. antonio.cabrera@utmg.org
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Cabrera
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
mesh_terms: D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D002916:Chylothorax / Q000517:prevention & control; D003422:Critical Care; D019587:Dietary Supplements; D004750:Enteral Nutrition; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007249:Inflammation; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support; D011184:Postoperative Period; D011228:Prealbumin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D002097:C-Reactive Protein