Effect of preoperative nutritional status on postoperative outcomes in children with congenital heart diseases undergoing surgical repair

Abstract

Background Infants and children with congenital heart disease (CHD) are at higher risk of faltering growth and developing malnutrition. The aim of this study was to evaluate the prevalence of malnutrition and nutritional status of children with CHD presenting for cardiac surgery in a developing country and study the effect of malnutrition on postoperative outcomes. This study aimed to report the prevalence of malnutrition in children with congenital heart disease undergoing cardiac surgery and evaluate the effect of preoperative nutritional status in children with CHD on the postoperative outcomes in Lebanon, a middle-income country.Methods This is a single centered retrospective cohort study which included 147 children affected with different CHD malformations. Demographics, clinical evaluation, including diagnosis, surgical complexity, and other postoperative indicators were collected. Anthropometric measurements were recorded. For children aged 1 month to 2 years, the Z-Score for ‘Weight for Height’, Weight-for-Age Z-Score, and for Height-for-Age Z-Score were utilized; and for children above 2 years of age, the body mass index (BMI) was utilized to classify the malnourished patients.Results The overall prevalence of malnutrition at the time of surgery was 24.5% with majority 86.1% being aged two years or less. The median duration of invasive MV was 7.5 ± 45.06 (0.0–216.0) hours. 66.7% of the cases required more than 7 days of hospital LOS. Malnutrition was significantly associated with an increased risk of infection postoperatively.Conclusion Children with CHD are at higher risk of developing malnutrition, a problem which is related to increased adverse outcomes following cardiac surgeries. In our cohort, malnutrition was significantly associated with an increased risk of infection postoperatively. Hence, physicians caring for children with congenital heart disease should be encouraged to identify, develop, and use specific pediatric nutritional screening tools and combined anthropometric stratification schemes for children at risk of malnutrition and to integrate strategies to optimize their nutritional status before and after surgery.

Preoperative Nutrition Status in Children with Congenital Heart Disease and Its Impact on Postoperative Outcomes – A Systematic Review and Meta-Analysis

“…A total of 4090 studies were identi ed via our search strategy and manual bibliography review, of which 16 studies meeting the eligibility criteria were included in the nal review (PRISMA diagram can be seen in Fig. 1) [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] . This data comprised a total of 2003 malnourished children and 4681 well-nourished children with CHD.…”

“…Six studies used weight-for-age z-score (WAZ) charts/software provided by the World Health Organization (WHO) 49,50 and de ned malnutrition as less than − 2 standard deviations (SD) [35][36][37][38][39]46 . Overall, 7 studies were conducted in high-income countries (HICs) 33,36,39,40,42,45,47 , 6 in upper-middle-income countries (UMICs) 35,37,38,43,46,48 , and 3 in lower-middle-income countries (LMICs) 34,41,44 based on the World Bank classi cation 51 . For subgroup analysis, UMIC and LMIC studies were combined into one category, called middle-income countries (MIC).…”

“…A Z-score of less than − 2 in any category was de ned as malnutrition. While extracting comparative data between malnourished and well-nourished patients, ventilation time was reported by 12 studies [33][34][35][36][37][38][39][40]43,[45][46][47] , LOS in ICU was reported by 11 studies [33][34][35][36][37][38][39][40][45][46][47] , LOS in hospital was reported by 8 studies 33,[35][36][37]42,43,45,47 , mortality was reported by 8 studies 33,36,41,42,[44][45][46]48 , postoperative infections rates by 3 studies 34,37,41 , and RACHS-1/STAT scores by 5 studies 33,34,36,38,45 . Post-operative infections included ventilator-associated pneumonia and bloodstream sepsis.…”