UK-WHO Growth Chart for 0-4 years showing Sam's growth so far.
Sam returns to clinic at the age of 4 months. He now weighs 5.5kg which is on the 2nd centile. He is still breast feeding but has 2 high calorie infant formula feeds each day of 90mls. He continues on furosemide and spironolactone twice daily. His mother reports he continues to get breathless and sweaty when feeding and struggles to finish his bottles. On examination he has mild subcostal recession and his liver is palpable 2cm below the costal margin. Echocardiogram shows the big perimembranous VSD with left to right shunt. The left ventricle is moderately dilated but there is good biventricular systolic function.