Impact Factor 2.349 | CiteScore 2.20
More on impact ›

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00429

The Impact of Pre-Operative Nutritional Status on Outcomes Following Congenital Heart Surgery

 Carey Lim1,  Joel Lim2*,  Rajesh Babu Moorakonda3, Chengsi Ong2, Yee Hui Mok2,  John C. Allen4, Judith Wong2, Teng Hong Tan2 and Jan Hau Lee2
  • 1National University Hospital, Singapore
  • 2KK Women's and Children's Hospital, Singapore
  • 3Singapore Clinical Research Institute, Singapore
  • 4Centre of Quantitative Medicine, DUKE-NUS Medical School, Singapore

Aims and Objectives

Malnutrition is common in children with congenital heart disease and may contribute to adverse outcomes. This study evaluates the impact of pre-operative nutritional status on outcomes after congenital heart surgery.


We conducted a retrospective cohort study enrolling children under 10 years old who underwent congenital heart surgery at a tertiary children's hospital from 2012 to 2016. Patients who had patent ductus arteriosus ligation only, genetic syndromes or global developmental delay were excluded. Outcome measures included 30-day mortality, intensive care unit (ICU) length of stay (LOS), hospital LOS, duration of mechanical ventilation and number of inotropes used post-operatively. We performed univariate/multivariable logistic regression analysis, adjusting for age, cyanotic cardiac lesion, co-morbidity and Risk Adjustment for Congenital Heart Surgery (RACHS-1) score.


302 children of median age 16.2 [interquartile range (IQR) 3.1, 51.4)] months were included. The most common cardiac lesions were ventricular septal defect (27.8%), atrial septal defect (17.9%) and Tetralogy of Fallot (16.6%). Median weight-for-age z-score (WAZ) was -1.46 (IQR -2.29, -0.61), height-for-age z-score (HAZ) was -0.94 (IQR -2.10, -0.10) and body mass index (BMI)-for-age z-score (BAZ) was -1.11 (IQR -2.19, -0.30).

In multivariable analysis, there was an increased risk of 30-day mortality for WAZ ≤ -2 versus WAZ > -2 (adjusted odds ratio (aOR): 4.01, 95% CI: 1.22, 13.13; p=0.022). For HAZ ≤ -2 versus HAZ > -2, there was increased risk of hospital LOS ≥ 7 days (aOR: 2.08, 95% CI: 1.12, 3.89; p=0.021), mechanical ventilation ≥ 48 hours (aOR: 2.63, 95% CI: 1.32, 5.24; p=0.006) and of requiring ≥ 3 inotropes post-operatively (aOR: 3.00, 95% CI: 1.37, 6.59; p=0.006).


In children undergoing congenital heart surgery, WAZ ≤ -2 is associated with higher 30-day mortality, while HAZ ≤ -2 is associated with longer durations of hospital LOS and mechanical ventilation, and increased risk of use of 3 or more inotropes post-operatively. Future studies are necessary to develop safe and efficacious peri-operative nutritional interventions, particularly in patients with WAZ and HAZ ≤ -2.

Keywords: nutrition, congenital heart disease, congenital heart surgery, Weight-for-Age Z- Score, Height-for-age z-score, Body Mass Index-For-Age Z-Score, outcomes

Received: 31 Jul 2019; Accepted: 07 Oct 2019.

Copyright: © 2019 Lim, Lim, Moorakonda, Ong, Mok, Allen, Wong, Tan and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Joel Lim, KK Women's and Children's Hospital, Singapore, Singapore,