Hemodynamic-Guided Nutrition Support in Pediatric Congenital Heart Disease.

PURPOSE OF REVIEW: Children with congenital heart disease (CHD) are at high risk of malnutrition, feeding difficulties and altered body composition beyond infancy. Nutritional decisions are often based on cardiac anatomy. Although anatomy alone does not capture differences in metabolic demand, mesenteric perfusion and feeding intolerance. This review presents physiology-based framework to guide nutritional support in pediatric CHD care pathway. RECENT FINDINGS: Recent evidence favors early enteral feeding when hemodynamically appropriate, prioritizing human milk in high-risk infants, standardizing perioperative feeding protocols, assessment beyond weight alone and early attention to oral feeding skills. Long term concern includes micronutrition deficiency, protein losing enteropathy, sarcopenia, obesity and feeding difficulties. Some evidence remains unclear in several areas including exact calorie and protein goal, hemodynamic feeding threshold, weight loss medications in pediatric CHD. Five hemodynamic categories (systemic hypoperfusion, global hypoxia, pulmonary over circulation, mixing lesions, and single-ventricle physiology) may providea practical way to guide nutrition decisions than anatomic diagnosis alone. Matching feeding strategy to mesenteric perfusion, metabolic demand, and complication risk may improve consistency of care but pediatric-specific prospective studies stratified by hemodynamic physiology with patient-centered endpoints are needed.