Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery

Abstract

Background Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery. Methods We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children’s Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes. Results We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ≤ −2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay. Conclusions This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality.

Tolerability and Effects of the Use of Energy‐Enriched Infant Formula After Congenital Heart Surgery: A Randomized Controlled Trial

“…Congenital heart disease (CHD) represents a public health issue due to its high incidence of 9/1000 live births . Undernutrition may occur in up to 90% of these patients and may be related to poorer surgical and neurological outcomes . Nutrition recovery may take several months to occur after surgery, and there is evidence that these children may not recover stature, remaining shorter in height than expected…”

“…1 Undernutrition may occur in up to 90% of these patients 2 and may be related to poorer surgical and neurological outcomes. 3,4 Nutrition recovery may take several months to occur after surgery, and there is evidence that these children may not recover stature, remaining shorter in height than expected. 5 The complexity of this group of patients often causes insecurity when beginning the diet and also frequent interruptions in feeding, which will contribute to a lower energy supply.…”

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

“…Malnutrition is a common problem for CHD patients, regardless of the presence of cyanosis and type of cardiac anomaly. In USA, 33% of children with CHD have acute and 64% have chronic malnutrition (11). Determination of the growth disturbance for cyanotic and acyanotic defects has been changed considerably over the past 25 years due to surgical interventions in early childhood, especially for patients with cyanotic lesions.…”

“…Several factors have been identified to contribute to the occurrence of malnutrition, such as increased mean total daily energy expenditure, decreased energy intake, increased oxygen consumption, disturbed absorption due to bowel congestion, inability of the tissues to use the nutrients and disturbed cellular metabolism due to under oxygenation (9). Children with complex heart lesions need beyond 120% of the common energy intake to have acceptable growth pattern (10,11). This situation is more critical for children, because besides the increased energy demand caused by CHD, they require more nutrient and energy for growth and neurodevelopment.…”

“…Nutritional challenges often appear at birth or soon after birth and growth impairment is more pronounced during neonatal period, especially for those with hemodynamicsignificant defects. Malnutrition causes both short-term complications, including longer hospital and Intensive care unit (ICU) stay, postoperative infection, long-term complications such as impaired neurodevelopment and mortality (11)(12)(13). Nutritional assessment and management in these children could result in remarkable improvement, including better results and less complications of the surgery, better growth and neurodevelopment and less imposed burden on the affected families and health care system; however, the first step in this regard, is to identify and evaluate the prevalence and severity of malnutrition and growth impairment on these patients.…”