الفهرس 
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Abstract
The aim of this study was improvement of nutritional status of children with congenital heart diseases and evaluate impact of nutritional counseling and support for those children.
In order to achieve this aim our study was conducted on forty-two malnourished male and female children with congenital heart disease aged more than 4 months at Outpatient and Inpatient Cardiology Unit of Pediatric Department at Zagazig University Children Hospital. All selected patients were subjected to nutritional assessment through full nutritional history taken, detailed history about breast feeding, artificial feeding and weaning. The SGA score was calculated for all patients. Full anthropometric measures were also done for them and routine laboratory investigations were done. Proper nutritional plan was applied for all patients by calculation of energy requirements according to the age plus extra calories for the cardiac condition which is about 30% of total caloric requirements. Follow up visits every 2 weeks were done with each visit the followings were done: weight measurement and counselling. And finally, patients were reassessed after 2 months with: full anthropometric measures, the subjective global assessment score and repetition of laboratory investigations.
Regarding gender distribution 50% of infants were females and the other were males with mean age 8.58 + 2.58 months and mean birth weight of them was 2.86+0.25 kg. Most of malnourished infants were breast feeder and fewer were artificial feeders.
Acyanotic CHDs were about 54.8% of our cases and the others were cyanotic. The most common anomaly was ASD followed by VSD in the acyanotic infants. While in cyanotic infants the most common anomaly was tetrology of fallot followed by dextrorotation. MAC pre, TSF pre and post, birth weight and weight post to nutrition support measurements were significantly lower in infants with pulmonary hypertension and HF than in those without. They were also found to have increased incidence of severe malnutrition than those without.
Pre to nutritional support intervention most of cases (54.8%) were of moderate degree while the other cases (45.2%) was of severe degree.
There was significant improvement in all anthropometric measurements post to nutritional support and there was significant increase in weight all over the study follow up intervals. There was no improvement in length.
There was a significant improvement regarding serum calcium, phosphorus and magnesium levels, while there was no significant change in serum sodium and potassium levels. Also, there was a significant improvement in hemoglobin levels and hematocrit percent. There was a significant reduction of platelets count post to nutrition support while, there was no significant changes in WBCs count.
There was a significant increase of blood urea, total plasma protein and serum albumin levels and there was a significant decrease in direct serum bilirubin.
Post to nutritional support intervention, our results showed that a significant improvement in degree of malnutrition as 85.7% become well nutrition. Similarly, according to Waterlow criteria for failure to thrive post to nutritional support, 85.7% of infants become improved and well-nourished while the other 14.3% infants had failure to thrive