Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

Abstract

Background:Patients with congenital heart disease (CHD) are susceptible to mild malnutrition up to failure to thrive. The prevalence of malnutrition among patients with CHD is higher in developing countries. Many factors are considered to affect the nutritional status such as cyanosis.Objectives: This study aims to assess the prevalence and severity of malnutrition in patients with CHD prior to the surgical corrective or palliative repair. Methods: This study was performed by reviewing inpatient medical records and cardiac surgery databases of children with cyanotic CHD who underwent palliative or corrective surgery between March 2011 and March 2017. Patients' age and height at the time of surgery, birth weight, duration of intensive care unit (ICU) stay and 30-day mortality were extracted and weight for age z score (WAZ), weight for length z score (WLZ) and length for age z score (LAZ) were calculated. Z scores above -1 were considered as normal, between -1 and -2 as mild, between -2 and -3 as moderate and below -3 as severe malnutrition. Results:In a total number of 639, the average age, weight and height were 16.688 ± 24.859 months, 7.509 ± 5.629 kilograms and 73.759 ± 95.869 centimeters, respectively. The average length of ICU stay was 8.36 ± 6.254 days and the 30-day mortality was 36 (5.7%). The average WAZ, LAZ, WLZ and BMI Z was -1.5 ± 1.69, -0.9 ± 2.38, -1.2 ± 3.97 and -1.4 ± 2.11, respectively. Regarding WAZ, LAZ, WLZ and BMI Z, 62.2%, 46.1%, 72.3% and 70.9% of patients had mild to severe forms of malnutrition, since the rate of malnutrition based on WAZ (P = 0.001), LAZ (P < 0.0001), WLZ (P < 0.0001) and BMI Z (P = 0.007), was significantly higher than normal subjects. Conclusions: The prevalence of mild to severe forms of malnutrition, based on different growth indices, for both cyanotics and acyanotics are higher than those reported in the other previous studies. These findings reflect the fact that cultural, genetic and racial differences of Iranians compared to others, cause malnutrition to be more frequent in Iranian CHD children. This calls for higher requirement of nutritional support for these patients.

Optimal Nutrition Parameters for Neonates and Infants with Congenital Heart Disease

“…The evaluation of nutritional status and growth in children is based on WAZ (weight for age), WHZ (weight for height), and HAZ (height for age) parameters. A cut-off Z-score < −2 classifies malnutrition into underweight (low WAZ), stunting (low HAZ), and wasting (low WHZ) [3].…”