{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:12:53Z","timestamp":1788343973296,"version":"build-2803163510"},"reference-count":101,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Danone SN Indonesia","award":["APC July 2026"],"award-info":[{"award-number":["APC July 2026"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Protein\u2013energy malnutrition is common in children with congenital heart disease (CHD) due to increased metabolic demand and limited oral intake capacity. Achieving adequate protein intake in this population through oral feeding remains a critical yet underexplored challenge. This review aims to synthesize the currently available evidence on protein requirements, barriers to oral intake, and strategies for optimization of protein delivery in children with CHD. Methods: A narrative review was conducted using PubMed\/MEDLINE, Scopus, and Web of Science. Relevant observational studies, randomized trials, guidelines, and recent reviews addressing nutritional management and oral feeding in pediatric CHD were included. Evidence was synthesized across metabolic, clinical, and practical domains. Results: Children with CHD exhibit increased protein requirements driven by hypermetabolism, inflammation, and perioperative stress, often reaching a requirement of 3\u20134 g\/kg\/day in high-risk settings. However, feeding limitations\u2014including fatigue, gastrointestinal dysfunction, and oral motor impairment\u2014restrict intake capacity and contribute to protein inadequacy in this population. Evidence supports the use of nutrient-dense feeding, optimized feeding frequency, food fortification, oral nutritional supplementation, and multidisciplinary care to improve protein delivery efficiency and nutritional status. Conclusions: Achieving adequate protein delivery through oral feeding requires a shift toward targeted, protein-focused strategies that address intake limitations. Early attention to protein adequacy may support nutritional recovery and growth, although its independent effects on postoperative and long-term outcomes remain uncertain. Further research is needed to establish standardized, evidence-based protocols tailored to this population.<\/jats:p>","DOI":"10.3390\/children13091159","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:33:52Z","timestamp":1787942032000},"page":"1159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Achieving Protein Requirements Through Oral Feeding in Children with Congenital Heart Disease: A Narrative Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Luciana B.","family":"Sutanto","sequence":"first","affiliation":[{"name":"Indonesia Nutrition Association, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray Wagiu","family":"Basrowi","sequence":"additional","affiliation":[{"name":"Danone Specialized Nutrition Indonesia, RDTX Place 9th Floor, South Jakarta 12940, Indonesia"},{"name":"Occupational Medicine Division, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10320, Indonesia"},{"name":"Health Collaborative Center, Jakarta 14410, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilna Khairunisa","family":"Shalihat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia"},{"name":"Adam Malik Hospital, Medan 20136, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3404-707X","authenticated-orcid":false,"given":"Refani Alycia","family":"Kusuma","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Faculty of Medicine, Universitas Negeri Semarang, Semarang 50229, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nova Lidia","family":"Sitorus","sequence":"additional","affiliation":[{"name":"Danone Specialized Nutrition Indonesia, RDTX Place 9th Floor, South Jakarta 12940, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0644-1795","authenticated-orcid":false,"given":"Dessy","family":"Pratiwi","sequence":"additional","affiliation":[{"name":"Danone Specialized Nutrition Indonesia, RDTX Place 9th Floor, South Jakarta 12940, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20593","DOI":"10.1097\/MD.0000000000020593","article-title":"Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990\u20132017","volume":"99","author":"Wu","year":"2020","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Vazzana, G.F., Romano, A., and Romano, C. 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