No CrossRef data available.
Article contents
Pre-operative nutritional status and its association with short-term post-operative outcomes in Iranian children with CHD
Published online by Cambridge University Press: 13 June 2022
Abstract
Background:
Nutritional assessment appears to be an essential component of the evaluation of children with CHD undergoing surgery because nutritional status may impact corrective surgery-associated morbidity.
Methods:
A prospective single-centre cohort study with children between 6 and 24 months of age. Patients who had genetic syndromes or those who were premature or low birthweight at birth were excluded. Pre-operative nutritional parameters included anthropometric measurements and serum concentrations of total protein, vitamin D, iron, and ferritin. Outcome measures included ICU length of stay, mechanical ventilation, vasoactive-inotropic score, and duration of inotropes. Linear regression analysis was performed to determine whether pre-operative variables were associated with outcomes.
Results:
Analysis was performed on 120 patients (median age of 8 months), of whom 67 were male. Prior to surgery, 50.8% of patients had reduced (z ≤ −2.0) weight-for-age z score, 23.3% had reduced length-for-age z score, and 59.2% had reduced mid-upper arm circumference z score. Pre-operative serum total protein levels were 59.36 ± 9.16 g/L. Multiple regression analysis showed that low serum protein was associated with longer ICU length of stay and length of mechanical ventilation, while mid-upper arm circumference z score ≤ −2 was associated with longer ICU length of stay and mechanical ventilation and inotropes duration.
Conclusions:
Pre-operative assessment of nutritional status by performing anthropometric and biochemical measurements including mid-upper arm circumference z score and serum protein concentrations in children undergoing CHD surgery appears to be predictors of some post-operative short-term outcomes and could be used as a guide to highlight patients needing appropriate perioperative nutritional interventions.
- Type
- Original Article
- Information
- Copyright
- © Shahid Beheshti University of Medical Sciences, 2022. Published by Cambridge University Press
References
Triedman, JK, Newburger, JW. Trends in Congenital Heart Disease: the next decade. Circulation 2016; 133: 2716–2733.CrossRefGoogle ScholarPubMed
Blasquez, A, Clouzeau, H, Fayon, M, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr 2016; 70: 528–531.CrossRefGoogle ScholarPubMed
Toole, BJ, Toole, LE, Kyle, UG, Cabrera, AG, Orellana, RA, Coss-Bu, JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis 2014; 9: 15–25.CrossRefGoogle ScholarPubMed
Ross, F, Latham, G, Joffe, D, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiol Young 2017; 27: 1716–1725.CrossRefGoogle ScholarPubMed
Cameron, JW, Rosenthal, A, Olson, AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med 1995; 149: 1098–1102.CrossRefGoogle ScholarPubMed
Hassan, BA, Albanna, EA, Morsy, SM, et al. Nutritional status in children with un-operated Congenital Heart Disease: an Egyptian center experience. Front Pediatr 2015; 3: 53.CrossRefGoogle ScholarPubMed
Varan, B, Tokel, K, Yilmaz, G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 1999; 81: 49–52.CrossRefGoogle ScholarPubMed
Ratanachu-Ek, S, Pongdara, A. Nutritional status of pediatric patients with congenital heart disease: pre- and post-cardiac surgery. J Med Assoc Thai 2011; 94 (Suppl 3): S133–S137.Google ScholarPubMed
Carmona, F, Hatanaka, LS, Barbieri, MA, et al. Catch-up growth in children after repair of Tetralogy of Fallot. Cardiol Young 2012; 22: 507–513.CrossRefGoogle ScholarPubMed
Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397–404 e1.CrossRefGoogle ScholarPubMed
Ross, FJ, Radman, M, Jacobs, ML, et al. Associations between anthropometric indices and outcomes of congenital heart operations in infants and young children: an analysis of data from the Society of Thoracic Surgeons Database. Am Heart J 2020; 224: 85–97.CrossRefGoogle ScholarPubMed
Lim, CYS, Lim, JKB, Moorakonda, RB, et al. The impact of pre-operative nutritional status on outcomes following Congenital Heart Surgery. Front Pediatr 2019; 7: 429.CrossRefGoogle ScholarPubMed
Henry, BM, Borasino, S, Ortmann, L, et al. Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass: a multi-centre retrospective study. Cardiol Young 2019; 29: 761–767.CrossRefGoogle ScholarPubMed
Ye, X, Dong, S, Deng, Y, et al. Preoperative vitamin D deficiency is associated with higher vasoactive-inotropic scores following pediatric cardiac surgery in Chinese children. Front Pediatr 2021; 9: 671289.CrossRefGoogle ScholarPubMed
Puri, K, Price, JF, Spinner, JA, et al. Iron deficiency is associated with adverse outcomes in pediatric heart failure. J Pediatr 2020; 216: 58–66 e1.CrossRefGoogle ScholarPubMed
Davidson, J, Tong, S, Hancock, H, Hauck, A, da Cruz, E, Kaufman, J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med 2012; 38: 1184–1190.CrossRefGoogle ScholarPubMed
Wallace, MC, Jaggers, J, Li, JS, et al. Center variation in patient age and weight at Fontan operation and impact on postoperative outcomes. Ann Thorac Surg 2011; 91: 1445–1452.CrossRefGoogle ScholarPubMed
Marwali, EM, Darmaputri, S, Somasetia, DH, Sastroasmoro, S, Haas, NA, Portman, MAJPI. Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country? Paediatr Indones 2015; 55: 109–116.CrossRefGoogle Scholar
Hopkins, D, Marino, L. Congenital Heart Disease. In: Shaw, V (ed). Clinical Paediatric Dietetics, 5th ed. Wiley; 2020: 282–307.CrossRefGoogle Scholar
Phong, RY, Taylor, SL, Robinson, BA, Jhawar, S, Nandalike, K. Utility of mid-upper arm circumference in diagnosing malnutrition in children with cystic fibrosis. Nutr Clin Pract 2020; 35: 1094–1100.CrossRefGoogle ScholarPubMed
Becker, PJ, Nieman Carney, L, Corkins, MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet 2014; 114: 1988–2000.CrossRefGoogle Scholar
Stephens, K, Escobar, A, Jennison, EN, et al. Evaluating mid-upper arm circumference Z-score as a determinant of nutrition status. Nutr Clin Pract 2018; 33: 124–132.CrossRefGoogle ScholarPubMed
Chomtho, S, Fewtrell, MS, Jaffe, A, Williams, JE, Wells, JC. Evaluation of arm anthropometry for assessing pediatric body composition: evidence from healthy and sick children. Pediatr Res 2006; 59: 860–865.CrossRefGoogle ScholarPubMed
Grijalva-Eternod, CS, Wells, JC, Girma, T, et al. Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants. Am J Clin Nutr 2015; 102: 593–599.CrossRefGoogle ScholarPubMed
Watanabe, T, Kinoshita, T, Itoh, K, et al. Pretreatment total serum protein is a significant prognostic factor for the outcome of patients with peripheral T/natural killer-cell lymphomas. Leuk Lymphoma 2010; 51: 813–821.CrossRefGoogle ScholarPubMed
Katsuki, M, Kakizawa, Y, Nishikawa, A, Yamamoto, Y, Uchiyama, T. Lower total protein and absence of neuronavigation are novel poor prognostic factors of endoscopic hematoma removal for intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2020; 29: 105050.CrossRefGoogle ScholarPubMed
Czempik, PF, Czepczor, K, Czok, MZ. Should we change reference range for serum albumin in major gastrointestinal surgery? Preoperative serum albumin as an important prognostic factor. J Perioper Pract 2020; 30: 271–276.Google ScholarPubMed
Arques, S. Serum albumin and cardiovascular disease: state-of-the-art review. Ann Cardiol Angeiol (Paris) 2020; 69: 192–200.CrossRefGoogle ScholarPubMed
Leite, HP, Rodrigues da Silva, AV, de Oliveira Iglesias, SB, Koch Nogueira, PC. Serum albumin Is an independent predictor of clinical outcomes in critically ill children. Pediatr Crit Care Med 2016; 17: e50–e57.CrossRefGoogle ScholarPubMed
Kittisakmontri, K, Reungrongrat, S, Lao-Araya, M. Hypoalbuminaemia at admission predicts the poor outcomes in critically ill children. Anaesthesiol Intensive Ther 2016; 48: 158–161.CrossRefGoogle ScholarPubMed
Leite, HP, Fisberg, M, de Carvalho, WB, de Camargo Carvalho, AC. Serum albumin and clinical outcome in pediatric cardiac surgery. Nutrition 2005; 21: 553–558.CrossRefGoogle ScholarPubMed