The Associations Between Preoperative Anthropometry and Postoperative Outcomes in Infants Undergoing Congenital Heart Surgery

Abstract

Aim:We explored the association between preoperative anthropometry and biochemistry, and postoperative outcomes in infants with CHD after cardiac surgery, as infants with congenital heart disease (CHD) often have feeding difficulties and malnutrition.MethodologyThis was a retrospective review of infants (≤ 1-year-old) who underwent congenital heart surgery. Preoperative anthropometryin terms of preoperative weight-for-age z-score (WAZ), length-for-age z-score (LAZ), as well as preoperative serum albumin and hemoglobin concentrations, were evaluated against 6-month mortality, and morbidity outcomes including postoperative complications, vasoactive inotrope score, duration of mechanical ventilation, length of stay in the pediatric intensive care unit and in hospital, using the logistic regression or median regression models accounting for infant-level clustering.ResultsOne hundred and ninety-nine operations were performed in 167 infants. Mean gestational age at birth was 38.0 (SD 2.2) weeks (range 26 to 41 weeks). Thirty (18.0%) infants were born preterm (<37 weeks). The commonest acyanotic and cyanotic lesions were ventricular septal defect (26.3%, 44/167), and tetralogy of Fallot (13.8%, 23/167), respectively. Mean age at cardiac surgery was 94 (SD 95) days. Feeding difficulties, including increased work of breathing during feeding, diaphoresis, choking or coughing during feeding, and inability to complete feeds, was present in 54.3% (108/199) of infants prior to surgery, of which 21.6% (43/199) required tube feeding. The mean preoperative WAZ was−1.31 (SD 1.79). Logistic regression models showed that low preoperative WAZ was associated with increased risk of postoperative complications (odds ratio 1.82; p = 0.02), and 6-month mortality (odds ratio 2.38; p = 0.008) following CHD surgery. There was no meaningful association between the other preoperative variables and other outcomes.ConclusionMore than 50% of infants with CHD undergoing cardiac surgery within the first year of life have feeding difficulties, of which 22% require to be tube-fed. Low preoperative WAZ is associated with increased postoperative complications and 6-month mortality.

Risk Factors of Chylothorax After Congenital Heart Surgery in Infants: A Single-Centre Retrospective Study

“…The need for sedation and enteral or parenteral nutrition during intubation for MV may lead to lung injury, which also increases the thoracic pressure. 26 Second, MV may cause barotrauma or volutrauma to the lungs, which may damage the lymphatic vessels and cause chyle to leak. Finally, MV may alter the haemodynamics and fluid balance in the thoracic cavity, which may affect the production and reabsorption of chyle.…”

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

“…Second, because of its retrospective aspect, we could not assess some pertinent factors that might affect outcome (such as albumin, anemia, social economic status, refugee status) as well as nutritional parameters such as body composition measures (triceps skinfold z-score, mid-arm circumference) (4). Third, we did not account for other confounding factors of adverse outcomes such as pre-existing cardiac dysfunction, aortic cross-clamp duration, cardiac bypass duration, and Vasoactive-Inotropic Score (VIS) which have been proved to have an association between Z-Score/BMI and length of ICU and mechanical ventilation period (20).…”

Nutritional Management of Patients with Fontan Circulation: A Potential for Improved Outcomes from Birth to Adulthood

“…During the pre-transplant period, the schedule of nutritional follow-up should be more frequent than usual. Indeed, a low WAZ has been associated with an increased risk of postoperative complications and 6-months mortality following CHD surgery [ 115 ].…”