Cardiac changes in children hospitalized with severe acute malnutrition: A prospective study at tertiary care center of northern India

Jain, Dharmendra; Rao, Sunil Kumar; Kumar, Dhilip; Kumar, Ashok; Sihag, Bhupendra Kumar

doi:10.1016/j.ihj.2020.01.005

Cited by 7 publications

(8 citation statements)

References 8 publications

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“…Undernutrition could be secondary to several underlying medical disease or conditions or these diseases may be a contributing factor. Cardiovascular diseases are one of the commonest medical conditions which are strongly associated with varying degrees of undernutrition (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Magnitude of Undernutrition and associated factors among children with cardiac disease in University of Gondar hospital, northwest Ethiopia

Asrade

Shehibo

Tigabu

2021

Preprint

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Background: Undernutrition and cardiac disease are interconnected in a vicious cycle. Children with cardiac disease suffer with different degree of undernutrition resulting in significant morbidity and mortality in developing countries. This study aimed to assess magnitude of undernutrition and associated factors among children with cardiac disease in University of Gondar hospital, northwest Ethiopia. Method: Hospital based quantitative cross-sectional study conducted among 269 children with cardiac disease visiting University of Gondar specialized hospital, northwest Ethiopia. Data was collected by using a pretested self-administered structured questionnaire and medical records of the patients. All participants who fulfill the inclusion criteria were included. The data analysed by using binary logistic regression model. Variables with p-value ≤ 0.2 in bivariate analysis were fitted to the final multivariable analysis and those variables with p-value ≤ 0.05 were considered as having statistically significant association to the outcome variable. AOR and 95% confidence interval was calculated to assess the strength of association between the variables. Result: Of the 269 study participants, 177(65.7%) of them were having undernutrition. 54.5% were underweight, 39.7% were stunted, and 53.9 % were wasted. The result showed that having pulmonary hypertension[AOR =3.82, (95%CI 1.80, 8.10)], NYHA/modified Ross class III and IV heart failure[AOR=4.64(1.69, 12.72)] and cardiac chamber enlargement [ AOR=2.91(1.45, 5.66)] were significantly associated with undernutrition. Conclusion: There is high burden of undernutrition among children with cardiac diseases in the study area. Nutritional management and dietary counseling besides early detection and treatment of the underlying heart disease improves the nutritional status of children with cardiac diseases.

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Section: Introductionmentioning

confidence: 99%

Magnitude of Undernutrition and associated factors among children with cardiac disease in University of Gondar hospital, northwest Ethiopia

Asrade

Shehibo

Tigabu

2021

Preprint

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“…Malnutrition increases risk of infection, diminishes wound healing and skin integrity, blunts the cortisol stress response, and decreases intestinal absorption ( 39 ). Several studies have also documented impaired left ventricular function that correlates with the degree of malnutrition ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy

Quinn

Gilley²,

Ta³

et al. 2022

Front. Pediatr.

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Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.

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“…The participants were selected by convenient sampling technique and with SAM prevalence of about 7.7% based on NFHS-5 survey and an expected response rate of 60%, the study would require 50 participants for estimating the expected proportion with 10% absolute precision and 95% confidence interval. [5][6][7][8][9][10][11][12][13] The data was analysed by SPSS software.…”

Section: Methodsmentioning

confidence: 99%

Study on the effect of severe acute malnutrition on various echocardiographic parameters of the heart

V.¹,

Ramanathan²

2023

Int J Contemp Pediatr

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Background: Malnutrition is a major cause for morbidity and mortality in children below 5 years of age in developing countries. According to National family health survey-5 (NFHS-5), stunting has reduced from 38.4% to 35.5%. Wasting has reduced from 21.0% to 19.3% and underweight prevalence has reduced from 35.8% to 32.1%. Acute malnutrition can lead to biochemical changes based on metabolic, hormonal and glucoregulatory mechanisms and can affect various organ systems. This study aims to determine the effect of malnutrition on various cardiac parameters by M mode echocardiography. Methods: A cross sectional observational study was conducted in 50 severe acute malnutrition children selected by convenient sampling between 6 months and 5 years of age of Government Cuddalore medical college for a period of 2 years and M mode echocardiography was done to assess various parameters of cardiac wall dimensions and cardiac mass and compared with age/body surface area specific values. Results: Among SAM children, 74% had decreased end diastolic diameter, 80% had decreased end systolic diameter and 88% had decreased posterior wall dimension. Ejection fraction and fractional shortening was in normal range for all children. 64% had decreased left ventricular mass and 56% had decreased left ventricular mass index. Conclusions: Dimensions of the heart and cardiac mass was reduced in majority of malnourished children. Systolic function of the heart was relatively preserved as demonstrated by normal ejection fraction and fractional shortening. Thus, echocardiography can serve as a valuable tool in detecting changes in cardiac structure and function in malnourished children.

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Cardiac changes in children hospitalized with severe acute malnutrition: A prospective study at tertiary care center of northern India

Cited by 7 publications

References 8 publications

Magnitude of Undernutrition and associated factors among children with cardiac disease in University of Gondar hospital, northwest Ethiopia

Magnitude of Undernutrition and associated factors among children with cardiac disease in University of Gondar hospital, northwest Ethiopia

Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy

Study on the effect of severe acute malnutrition on various echocardiographic parameters of the heart

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