Introduction Chronic heart failure is associated with cardiac cachexia. Cardiac cachexia refers to a syndrome of protein-energy malnutrition. We studied the severity of malnutrition in children with end-stage cardiomyopathy (CMP) admitted to the pediatric intensive care unit (PICU).

Methods Retrospective study of 42 patients with circulatory failure due to CMP necessitating cardiac support. Malnutrition was defined as weight for age (WFA) <−2 SD. Numbers expressed as median and range.

Results Forty-two patients, age 7.0 years (0.2–16.7 yrs), 55% male, were analyzed. CMP was classified as: 82% dilated, 5% hypertrophic, 9% restrictive and 5% noncompaction. Duration of stay was 26 days (1–187 d). WFA on admission was −1.5 SD (−3.7–1.9 SD). Lowest WFA during admittance was −2.2 SD (−6.1–1.9 SD). WFA-SDS <−2 was seen in 38% of children on admission and 52% during admission. Thirty-six (86%) patients were admitted >5 days. In this group weight loss occurred during admission accounting for a decrease of 0.6 SD (0.0–4.0 SD). Enteral and/or parenteral nutritional support was given in 81% of the patients.

Conclusion Over half of the children with cardiomyopathy admitted to the PICU suffered from malnutrition. Despite dietary support 90% lost weight during admission due to diminished fluid overload and cachexia. Increased metabolic rates, malabsorption, anorexia due to a proinflammatory state or delayed gastric emptying and fluid restriction can lead to an imbalance in energy intake and energy requirement.