With Dilated Cardiomyopathy

Abstract: This article describes nutri-tion implications of pediatric dilated cardiomyopathy leading to heart trans-plantation with a focus on nutritional management of patients during the waiting time for a donor organ and the inpatient postoperative period. Optimization of nutritional status is essential during these periods as weight loss and malnutrition contribute to muscle atrophy, decreased functional capacity, reduced immune function, and prolonged hospital stay. Nutrition implications of heart failure vary with patient’s age and degree of symptoms. Infants may have increased caloric needs and poor feeding often due to tachypnea. Older children, 1-18 years, may have decreased appetite, abdom-inal pain, and vomiting. Ventricular assist devices or extracorporeal mem-brane oxygenation, necessary to sustain life in some cases, have addi-tional nutrition implications related to wound healing from insertion of the device and device-related compli-cations that can include pancreatitis and the need for total parenteral nutri-tion. Once symptomatic heart failure is relieved and heart transplant occurs, caloric needs often decrease while inter-est in eating can increase profoundly, changing the overall nutrition diag-nosis and the need for nutrition sup-port. A case series involving an infant, a young child, and an adolescent is presented to illustrate nutritional chal-lenges and interventions for pediatric patients awaiting heart transplant and the inpatient postoperative period