{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:25:39Z","timestamp":1790832339759,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Congenital heart disease (CHD) affects 1% of live births globally. Infants with CHD often experience growth faltering and malnutrition due to increased metabolic demands, malabsorption, and feeding intolerance, further worsened by surgical interventions and frequent hospitalizations. Malnutrition in this population is linked to higher morbidity, extended hospital stays, and poor neurodevelopmental outcomes. The physiological diversity among CHD types presents significant challenges in developing a universal feeding strategy to optimize nutrition. This narrative review explores the interplay between CHD physiology and nutritional management. CHD types could be categorized into three hemodynamic groups\u2014systemic hypoperfusion, global hypoxia, and pulmonary overcirculation\u2014which help to consider a feeding approach based on such physiology. Nutritional management in these infants could be further tailored based on the disease severity, co-morbidities, and evolving hemodynamic changes. Based on clinical opinions, this review proposes a hemodynamic-focused risk-stratified feeding approach, considering ways that may enhance growth while possibly minimizing complications such as necrotizing enterocolitis (NEC), pulmonary overload, and worsening heart failure. This approach may help individualize nutritional management to address the complex needs of infants with CHD. Further quality improvement studies are needed to assess this approach. Beyond meeting macronutrient needs, micronutrients, including zinc, thiamine, magnesium, vitamin A, and calcium, potentially play a role in cardiovascular health. Given the complexity of nutritional management in these infants, a multidisciplinary team may be needed to optimize care, including cardiologists, neonatologists, pediatricians, dietitians, speech therapists, and pharmacists. With the current knowledge gap and lack of strong evidence, research should focus on nutritional interventions and study their potential impact on infant outcomes with CHDs.<\/jats:p>","DOI":"10.3390\/jcdd12020038","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T09:52:20Z","timestamp":1737539540000},"page":"38","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Feeding Approach to Optimizing Nutrition in Infants with Congenital Heart Disease"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2421-2572","authenticated-orcid":false,"given":"Belinda","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA"},{"name":"Department of Pediatrics, Division of Neonatology, University of California Davis Health, Sacramento, CA 95817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Woodbury","sequence":"additional","affiliation":[{"name":"Nutrition Service, University of Utah Hospital, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libbi","family":"Hazelwood","sequence":"additional","affiliation":[{"name":"Nutrition Service, University of Utah Hospital, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5207-9019","authenticated-orcid":false,"given":"Yogen","family":"Singh","sequence":"additional","affiliation":[{"name":"Nutrition Service, University of Utah Hospital, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1017\/S1047951117001068","article-title":"Preoperative malnutrition is associated with increased mortality and adverse outcomes after pediatric cardiac surgery","volume":"27","author":"Ross","year":"2017","journal-title":"Cardiol. Young"},{"key":"ref_2","first-page":"373","article-title":"Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol","volume":"11","author":"McCulley","year":"2010","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1542\/peds.106.5.1080","article-title":"Necrotizing enterocolitis in neonates with congenital heart disease: Risk factors and outcomes","volume":"106","author":"McElhinney","year":"2000","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/0148607113487926","article-title":"From parenteral to enteral nutrition: A nutrition-based approach for evaluating postnatal growth failure in preterm infants","volume":"38","author":"Miller","year":"2014","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1177\/0148607116664560","article-title":"Transitioning preterm infants from parenteral nutrition: A comparison of 2 protocols","volume":"41","author":"Miller","year":"2017","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1038\/s41372-021-00928-8","article-title":"A preoperative standardized feeding protocol improves human milk use in infants with complex congenital heart disease","volume":"41","author":"Roddy","year":"2021","journal-title":"J. Perinatol."},{"key":"ref_7","first-page":"373","article-title":"Nutrition in congenital heart disease: Consensus document","volume":"98","author":"Tejero","year":"2023","journal-title":"An. Pediatr. (Engl. Ed.)"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Salvatori, G., De Rose, D.U., Massolo, A.C., Patel, N., Capolupo, I., Giliberti, P., Evangelisti, M., Parisi, P., Toscano, A., and Dotta, A. (2022). Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071841"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jpeds.2021.06.047","article-title":"A fetal risk stratification pathway for neonatal aortic coarctation reduces medical exposure","volume":"237","author":"Maskatia","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/ANC.0000000000000919","article-title":"Abdominal ultrasound assists the diagnosis and management of necrotizing enterocolitis","volume":"21","author":"Chan","year":"2021","journal-title":"Adv. Neonatal Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106083","DOI":"10.1016\/j.earlhumdev.2024.106083","article-title":"Value of near-infrared spectroscopy in evaluating the risk of neonatal necrotizing enterocolitis: A systematic review and meta-analysis","volume":"195","author":"Gan","year":"2024","journal-title":"Early Hum. Dev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1007\/s00246-014-0931-5","article-title":"Splanchnic near-infrared spectroscopy and risk of necrotizing enterocolitis after neonatal heart surgery","volume":"35","author":"DeWitt","year":"2014","journal-title":"Pediatr. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/ppul.24635","article-title":"Using lung ultrasound to evaluate pulmonary water content","volume":"55","author":"Zong","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.pedneo.2024.02.006","article-title":"Lung ultrasound in the evaluation of pulmonary edema in newborns with critical congenital heart disease","volume":"65","author":"Kaya","year":"2024","journal-title":"Pediatr Neonatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.jacc.2010.03.085","article-title":"Changing mortality in congenital heart disease","volume":"56","author":"Khairy","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1007\/s00246-021-02691-1","article-title":"Necrotizing enterocolitis in children with congenital heart disease: A literature review","volume":"42","author":"Kelleher","year":"2021","journal-title":"Pediatr. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Burge, K.Y., Gunasekaran, A., Makoni, M.M., Mir, A.M., Burkhart, H.M., and Chaaban, H. (2022). Clinical characteristics and potential pathogenesis of cardiac necrotizing enterocolitis in neonates with congenital heart disease: A narrative review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11143987"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1055\/s-0034-1390349","article-title":"Necrotizing enterocolitis in infants with ductal-dependent congenital heart disease","volume":"32","author":"Becker","year":"2014","journal-title":"Am. J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Mills, K.I., Kim, J.H., Fogg, K., Goldshtrom, N., Graham, E.M., Kataria-Hale, J., Osborne, S.W., and Figueroa, M. (2022). Nutritional considerations for the neonate with congenital heart disease. Pediatrics, 150.","DOI":"10.1542\/peds.2022-056415G"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jpeds.2008.04.074","article-title":"Enteral feeding in prostaglandin-dependent neonates: Is it a safe practice?","volume":"153","author":"Willis","year":"2008","journal-title":"J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1038\/sj.jp.7211691","article-title":"Umbilical artery catheters do not affect intestinal blood flow responses to minimal enteral feedings","volume":"27","author":"Havranek","year":"2007","journal-title":"J. Perinatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"200126","DOI":"10.1016\/j.jpedcp.2024.200126","article-title":"Cerebral and Splanchnic Tissue Oxygenation Are Significantly Affected in Premature infants with Ductal-Dependent Congenital Heart Disease","volume":"14","author":"Mankouski","year":"2024","journal-title":"J. Pediatr. Clin. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00134-019-05922-5","article-title":"Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations","volume":"46","author":"Tume","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jpeds.2019.08.009","article-title":"Human milk muse in the perioperative period is associated with a lower risk for necrotizing enterocolitis in neonates with complex congenital heart disease","volume":"215","author":"Cognata","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Faienza, M.F., D\u2019Amato, E., Natale, M.P., Grano, M., Chiarito, M., Brunetti, G., and D\u2019Amato, G. (2019). Metabolic bone disease of prematurity: Diagnosis and management. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00143"},{"key":"ref_26","unstructured":"National Institute for Health and Care Excellence (NICE) (2024, November 25). Neonatal Parenteral Nutrition, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK555677\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.jpedsurg.2012.01.039","article-title":"Reduced aluminum contamination decreases parenteral nutrition-associated liver injury","volume":"47","author":"Alemmari","year":"2012","journal-title":"J. Pediatr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/jpen.1692","article-title":"An observational study of Smoflipid vs. Intralipid on the evolution of intestinal failure-associated liver disease in infants with intestinal failure","volume":"44","author":"Belza","year":"2020","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Rastegar, M., Teshnizi, S., and Khaleghinia, M. (2024). Vitamin D and zinc deficiency in children with congenital heart defects. J. Comp. Pediatr., 15.","DOI":"10.5812\/jcp-145841"},{"key":"ref_30","first-page":"601","article-title":"Serum zinc values in children with congenital heart disease","volume":"13","author":"Sadoh","year":"2013","journal-title":"Afr. Health Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"303S","DOI":"10.1093\/ajh\/1.3.303S","article-title":"Taste acuity and zinc metabolism in captopril-treated hypertensive male patients","volume":"1","author":"Desai","year":"1988","journal-title":"Am. J. Hypertens."},{"key":"ref_32","first-page":"373","article-title":"Diuretics and zinc","volume":"62","author":"Reyes","year":"1982","journal-title":"S. Afr. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/030006059001800207","article-title":"Renal excretory actions of furosemide, of hydrochlorothiazide and of the vasodilator flosequinan in healthy subjects","volume":"18","author":"Leary","year":"1990","journal-title":"J. Int. Med. Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Terrin, G., Boscarino, G., Di Chiara, M., Iacobelli, S., Faccioli, F., Greco, C., Onest\u00e0, E., Sabatini, G., Pietravalle, A., and Oliva, S. (2020). Nutritional intake influences zinc levels in preterm newborns: An observational study. Nutrients, 12.","DOI":"10.3390\/nu12020529"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Marreiro, D.D., Cruz, K.J., Morais, J.B., Beserra, J.B., Severo, J.S., and de Oliveira, A.R. (2017). Zinc and oxidative stress: Current mechanisms. Antioxidants, 6.","DOI":"10.3390\/antiox6020024"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4597","DOI":"10.1007\/s00431-024-05756-4","article-title":"Thiamine: An indispensable regulator of pediatric neuro-cardiovascular health and diseases","volume":"183","author":"Ysphaneendramallimoggala","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.arcped.2022.08.017","article-title":"Shoshin beriberi and thiamine-responsive right heart failure: A case report in Mayotte","volume":"29","author":"Nguyen","year":"2022","journal-title":"Arch. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e939008","DOI":"10.12659\/AJCR.939008","article-title":"Lactic acidosis due to thiamine deficiency in a preterm infant associated with inadequate parenteral nutrition","volume":"24","author":"Hasan","year":"2023","journal-title":"Am. J. Case Rep."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Leigh, R.S., and Kaynak, B.L. (2020). Vitamin A as a transcriptional regulator of cardiovascular disease. Hearts, 1.","DOI":"10.3390\/hearts1020013"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/978-3-030-42282-0_5","article-title":"Retinoic Acid Signaling and Heart Development","volume":"95","author":"Perl","year":"2020","journal-title":"Sub-Cell. Biochem."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Cammisotto, V., Nocella, C., Bartimoccia, S., Sanguigni, V., Francomano, D., Sciarretta, S., Pastori, D., Peruzzi, M., Cavarretta, E., and D\u2019Amico, A. (2021). The Role of Antioxidants Supplementation in Clinical Practice: Focus on Cardiovascular Risk Factors. Antioxidants, 10.","DOI":"10.3390\/antiox10020146"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/qjmed\/hcy218","article-title":"Night blindness, Bitot\u2019s spot and vitamin A deficiency","volume":"112","author":"Mishra","year":"2019","journal-title":"QJM"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1161\/01.HYP.23.2.174","article-title":"Dose-related effects of magnesium on myocardial function in the neonate","volume":"23","author":"Caspi","year":"1994","journal-title":"Hypertension"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Fritzen, R., Davies, A., Veenhuizen, M., Campbell, M., Pitt, S.J., Ajjan, R.A., and Stewart, A.J. (2023). Magnesium deficiency and cardiometabolic disease. Nutrients, 15.","DOI":"10.3390\/nu15102355"},{"key":"ref_45","unstructured":"Gomella, T., Cunningham, M., Eyal, F.G., and Tuttle, D.J. (2013). Magnesium Disorders (Hypomagnesemia, Hypermagnesemia). Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs, McGraw-Hill Education. [7th ed.]. Available online: https:\/\/accesspediatrics.mhmedical.com\/content.aspx?bookid=1303&sectionid=79658865."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Fiorentini, D., Cappadone, C., Farruggia, G., and Prata, C. (2021). Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency. Nutrients, 13.","DOI":"10.3390\/nu13041136"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Pitzer Mutchler, A., Huynh, L., Patel, R., Lam, T., Bain, D., Jamison, S., Kirabo, A., and Ray, E.C. (2023). The role of dietary magnesium deficiency in inflammatory hypertension. Front. Physiol., 14.","DOI":"10.3389\/fphys.2023.1167904"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12576-024-00906-7","article-title":"Regulation of myocardial contraction as revealed by intracellular Ca2+ measurements using aequorin","volume":"74","author":"Kurihara","year":"2024","journal-title":"J. Physiol. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1136\/hrt.2007.119792","article-title":"Hypocalcaemia and vitamin D deficiency: An important, but preventable, cause of life-threatening infant heart failure","volume":"94","author":"Maiya","year":"2008","journal-title":"Heart"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Ibrahim, M., El Raichani, N., Otis, A.S., and Lavoie, J.C. (2024). Parenteral Cysteine Supplementation in Preterm Infants: One Size Does Not Fit All. Biomedicines, 12.","DOI":"10.3390\/biomedicines12010063"},{"key":"ref_51","unstructured":"DeTallo, C. (2019). The Practitioner\u2019s Guide to Nutrition-Focused Physical Exam of Infants, Children, and Adolescents: An Illustrated Handbook, Academy of Nutrition and Dietetics."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jpeds.2020.08.039","article-title":"A Multi-Interventional Nutrition Program for Newborns with Congenital Heart Disease","volume":"228","author":"Johnson","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e080","DOI":"10.1097\/pq9.0000000000000080","article-title":"Evaluating the impact of a feeding protocol in neonates before and after biventricular cardiac surgery","volume":"3","author":"Neary","year":"2018","journal-title":"Pediatr. Qual. Saf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/chd.12390","article-title":"Perioperative feeding approaches in single ventricle infants: A survey of 46 centers","volume":"11","author":"Slicker","year":"2016","journal-title":"Congenit. Heart Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/chd.12435","article-title":"Reducing variation in feeding newborns with congenital heart disease","volume":"12","author":"Simsic","year":"2017","journal-title":"Congenit. Heart Dis."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/2\/38\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:33:48Z","timestamp":1759919628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/2\/38"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":55,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcdd12020038"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12020038","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]}}}