AUTHOR=Lim Carey Yun Shan , Lim Joel Kian Boon , Moorakonda Rajesh Babu , Ong Chengsi , Mok Yee Hui , Allen John Carson , Wong Judith Ju-Ming , Tan Teng Hong , Lee Jan Hau 

TITLE=The Impact of Pre-operative Nutritional Status on Outcomes Following Congenital Heart Surgery

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 7 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2019.00429

DOI=10.3389/fped.2019.00429

ISSN=2296-2360

ABSTRACT=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. 

Methods

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.

Results

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).

Conclusion

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.