8–12 months 12–16 months 16–20 months 20–24 months 2–10 years 0.28–0.37 cm/wk 0.24–0.33 cm/wk 0.21–0.29 cm/wk 0.19–0.26 cm/wk 5–8 cm/y 0.08–0.11 cm/wk 0.04–0.08 cm/wk 0.03–0.06 cm/wk 0.02–0.04 cm/wk N/A Table 86.6 Estimated Energy and Protein Requirements for Children60 Recommended Dietary Allowance 0–6 months 108 7 months to 1 98 year 1–3 years 102 4–6 years 90 7–10 years 70 11–14 years Male 55 Female 45 15–18 years Male 47 Female 40 Age Energy Required for Catch-up Growth (kcal/kg per day) 120–150+ 110–140 Protein (g/kg per day) 2.2–3.5 1.5–2.5 100–120 80–100 60–90 1.2–2.0 1.2–1.5 1.2–1.5 55–60 45–60 1.0–1.5 1.0–1.5 45–55 45–55 1.0–1.5 1.0–1.5 Special considerations: Estimated needs may be affected by ventilation, sedation, or mechanical support Table 86.7 Estimated Fluid Requirements61 Weight (kg) 1–10 kg 11–20 kg >20 kg Fluid 100 mL/kg per day 1000 mL + 50 mL/kg for each kg >10 kg 1500 mL + 20 mL/kg for each kg >20 kg Table 86.8 Formulas for Chylothorax (High Medium-Chain Triglyceride and/or Low Long-Chain Triglyceride Content) Formula Type Liquid concentrate 30 Enfaporta (Mead Johnson) calories/ounce Powder MCT:LCT Ratio 83:17 Percent Calories From LCT Fat 7.8 LCT Fat g/100 Calories 0.9 80:20 7.6 0.82 Lipistarta (Néstle) Monogena (Nutricia) Portagena,b (Mead Johnson) Tolerexc (Néstle) Vivonex Pediatricc (Néstle) Vivonex TENc (Néstle) Powder 83:17 4.5 0.5 Powder 87:13 5.5 0.6 Powder 0:100 0.2 Powder 70:30 7.5 0.87 Powder 0:100 0.3 a Contains milk proteins bLong-term usage: Portagen powder is not nutritionally complete If used long term, supplementation of essential fatty acids and ultra-trace minerals should be considered (manufacturer's notation) cElemental, 100% free amino acids LCT, Long-chain triglyceride; MCT, medium-chain triglyceride Data from manufacturers' product labels as of April 2018 Please note product composition may be changed by the discretion of manufacturers Etiology of Malnutrition Inadequate Nutrient Intake Inadequate caloric and protein intake, including underestimated nutrient requirements or energy imbalance, is frequently cited as a major contributing factor to growth failure and malnutrition in children with congenitally malformed hearts.22 It is also one of the most modifiable factors associated with favored growth.23,24 Disordered oral feeding skills and inadequate oral intake may also significantly contribute to inadequate calories The feeding patterns of neonates with CHD have been compared with matched subgroups of infants with structurally normal hearts.15,25 For infants with congenitally malformed hearts, oral feeding demands increased amounts of energy Feeding intolerance can be attributed to an inability to expend sufficient energy on feeding, as exhibited by tachycardia, tachypnea, shortness of breath, and vomiting Other contributing factors include: ■ Early satiety ■ Decreased gastric capacity caused by hepatosplenomegaly ■ Delayed gastric emptying time ■ Dysmotility ■ Uncoordinated suck ■ Abnormal patterns of swallowing and breathing due to tachypnea In addition, fluid restrictions and diuretic therapy as part of the medical management may hinder provision of adequate caloric intake Hypermetabolism The energy available for metabolism is the sum of total energy expenditure and energy stored Basal metabolic rate represents the major component of total energy expenditure In general, children have a higher metabolic rate than adults, placing them at high risk for energetic deficiencies during episodes of acute illness.15,26 Children with congestive heart failure have been reported to have up to five times higher basal metabolic rates than children without cardiac disease.22 The elevated basal metabolic rate is likely due to the increased workload of the cardiac and respiratory systems Resting energy expenditure has been shown to be increased in malnourished infants with congestive cardiac failure.15 Frequent respiratory infections and fever will also contribute to a state of hypermetabolism because the presence of inflammation may promote catabolism.27 Malabsorption The etiology of malabsorption is multifactorial and contributes to malnutrition in children with CHD Malabsorption can result from GI tissue hypoxia, which may lead to feeding intolerance, limited caloric intake, and decreased nutrient utilization.28 Those with cardiac lesions resulting in right-sided cardiac failure and increased systemic venous pressure may develop edema of the intestinal wall and mucosal surfaces or poor splanchnic perfusion These alterations in the ...Lipistarta (Néstle) Monogena (Nutricia) Portagena,b (Mead Johnson) Tolerexc (Néstle) Vivonex Pediatricc (Néstle) Vivonex TENc (Néstle) Powder 83:17 4.5 0.5 Powder 87:13 5.5 0.6 Powder 0:100