Nutrition for Infants with Congenital Heart Disease

Nancy McDaniel M.D.

Feeding the infant with a congenital heart defect can be challenging to parents, caretakers and health care professionals. Depending on the type and severity of the congenital heart defect, infants may experience increased work of breathing and are thus unable to take in adequate oral intake. As a result infants with congenital heart defects often demonstrate delayed weight gain, linear growth and development. The infant with congenital heart defects may be adequately nourished with either formula or breast milk, but the parents and caretakers should remain flexible about the formulation and feeding method. Infants and small children who have a history of poor weight gain and failure to thrive, formula concentration and/or formula or breast milk supplementation are required in order to provide the child greater caloric and nutrient intake. Formula or breast milk caloric density may be increased by any one of a combination of the following methods:

  • Concentration: increasing the amount of formula base or decreasing the amount of free water when mixing a formula.
  • Supplementation: adding a nutrient module, such as carbohydrate or fat, in order to increase the caloric density without increasing all other nutrient sources.

Concentration Methods

Standard infant formulas, which provide 20 calories/ounce can be prepared to 24 calories/ounce by any one of the following methods:

  • Increasing Formula Caloric Density to 24 calories/ounce
    • Recipe for Formula Mixing
      • 13 oz formula concentrate + 9 oz water
      • 1 cup powdered formula + 3 cups water
      • 2 -1/2 scoops powdered formula + 4 oz water
      • 1/2 scoop powdered formula + 4 oz ready-to-feed

Supplementation Methods

  • Formula Supplementation - formula caloric density may be increased to 27 - 30 calorie/ounce by adding a carbohydrate and/or fat module as follows:
    Step Formula Volume Carbohydrate* Canola Oil calorie/oz
    1 4 oz of 24 cal/oz 1 tsp 1 cc 27
    2 4 oz of 24 cal/oz 2 tsp 2 cc 30
  • Breast Milk Supplementation - breast milk caloric and nutrient density may be increased by any one of the following methods:
    1. Method 1 - adding powdered or liquid breast milk fortifier Breast fed preterm infants with congenital heart defects may be supplemented with breast milk fortifier:
      Step Enfamil HM Fortifier Breast Milk Caloric Density
      1 1 packet 50 cc 22 calorie/oz
      2 1 packet 25 cc 24 calorie/oz
    2. Method 2 - adding caloric modules to the formula Breast milk caloric density can be increased without also increasing other nutrients such as sodium and potassium by adding caloric modules:
      Step Breast Milk Volume Carbohydrate* Canola Oil calorie/oz
      1 4 oz 1 tsp 1 cc 23
      2 4 oz 2 tsp 2 cc 26
    3. Method 3 - Breast milk caloric and nutrient density for term infants may be increased to 24 calorie/oz by:
      Add 1/2 scoop of powdered infant formula to 4 oz of breast milk

* Carbohydrate modules include Polycose (Ross) or Moducal (Mead-Johnson) and contain 8-10 calorie/tsp. Liquid Polycose may be substituted for powdered Polycose as follows: 1 tsp powdered = 4 ml of liquid Polycose

Solid Food Supplementation - strained infant foods such as strained cereal, fruits, vegetables and mixed dinner may be calorically fortified using corn syrup and margarine. A total of 1/2 - 1 tsp of corn syrup or margarine may be added per 4 oz of strained food as tolerated.

Supplemental Vitamin Intake - if your infant is unable to take in at least 25 oz of breast milk or formula per day, he or she may require pediatric multivitamin supplementation. If you have questions about vitamin supplementation, ask your child's doctor or nutritionist.