Advertisement

Did Malnutrition Affect Post-Operative Somatic Growth in Pediatric Patients Undergoing Surgical Procedures for Congenital Heart Disease?

  • Liza Fitria
  • Putri Caesa
  • Juweni Joe
  • Eva M. Marwali
Original Article

Abstract

Objectives

This study aims to investigate the impact of pre-operative malnutrition on nutritional outcome following congenital heart defects surgery.

Design

This is a prospective cohort study.

Setting

Pediatric Cardiac Intensive Care, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia.

Patient

Pediatric patients, aged younger than 36 months old with Aristotle score of 6–10, undergoing congenital heart defects surgery with cardiopulmonary bypass were included in this study.

Measurement

The measured outcome was nutritional outcome based on body weight changes before and after corrective surgery. The measured variables were age, gender, Aristotle score, caloric intake (in pediatric cardiac intensive care unit and pediatric ward), length of stay, albumin level, and prealbumin level.

Results

Among 185 patients, 6% increase of body weight was observed within 12 days of observation (p = 0.007). From bivariate analysis, post-operative nutritional status improvement was significantly associated with pre-operative Z-score for weight-for-age (p = 0.011), caloric intake in pediatric ward (p < 0.0001), and prealbumin level (p = 0.038). From multivariate analysis, caloric intake in pediatric ward remained as a factor which significantly determined post-operative nutritional status (p = 0.001, OR = 1.33, 95% CI 1.014–1.053).

Conclusion

Malnourished patients may have significant improvement in somatic growth following corrective surgery but no effect was observed on the post-operative body weight gain. Adequate nutritional support is important to ensure optimal recovery and better nutritional outcome.

Keywords

Cardiopulmonary bypass Cardiac surgery Congenital heart defect Malnutrition Somatic growth 

Notes

Acknowledgements

We like to thank our dietitian, Warniati, AMG and our statistician, Nunung Nursyarofah, SKM, MKM.

Compliance with Ethical Standards

Conflict of interest

All authors declared that they had no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

Research involving human participants and/or animals.

Informed Consent

Informed consent was obtained from all participants included in the study.

References

  1. 1.
    Schultz AH, Localio AR, Clark BJ, Ravishankar C, Videon N, Kimmel SE (2008) Epidemiologic features of the presentation of critical congenital heart disease: implicationsfor screening Pediatrics 121:751–757CrossRefGoogle Scholar
  2. 2.
    Venugopalan P, Akinbami FO, Al-Hinai KM, Agarwal AK (2001) Malnutrition in children with congenital heart defects. Saudi Med J 22(11):964–967PubMedGoogle Scholar
  3. 3.
    Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A et al (2014) The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thor Cardiovasc Surg 147(1):442–450CrossRefGoogle Scholar
  4. 4.
    Marwali E, Darmaputri S, Somasetia D, Sastroasmoro S, Haas N, Portman M (2015) Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country? Paediatrica Indonesiana 55(2):109–116CrossRefGoogle Scholar
  5. 5.
    Marwali EM, Kekalih A, Haas NA (2012) The effect of malnutrition on T3 levels in pediatric patients undergoing congenital heart surgery. Crit Care Shock 15:104–110Google Scholar
  6. 6.
    Okoromah C, Ekure E, Lesi F, Okunowo W, Tijani B, Okeiyi J (2011) Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child 96(4):354–360CrossRefGoogle Scholar
  7. 7.
    Marwali EM, Budiwardhana N, Portman MA et al (2017) Oral triiodothyronine for infants and children undergoing cardiopulmonary bypass (OTICC). Ann Thor Surg 104:688–697CrossRefGoogle Scholar
  8. 8.
    Onyango AW, de Onis M (2008) World Health Organization Child Growth Standards: training course on child growth assessment. WHO Press, GenevaGoogle Scholar
  9. 9.
    Oey Kam Nio (1992) Dietary food analysis. Balai Penerbit FKUI, JakartaGoogle Scholar
  10. 10.
    Vaidyanathan B, Nair SB, Sundaram KR et al (2008) Malnutrition in children with congenital heart disease (CHD) determinants and short-term impact of corrective intervention. Indian Pediatr 45:541–546PubMedGoogle Scholar
  11. 11.
    Vaidyanathan B, Radhakrishnan R, Sarala DA et al (2009) What determines nutritional recovery in malnourished children after correction of congenital heart defects? Pediatrics 124:e294–e299CrossRefGoogle Scholar
  12. 12.
    Owens JL (2009) Nutrition support after neonatal cardiac surgery. Nutr Clin Pract 24(2):242–249CrossRefGoogle Scholar
  13. 13.
    Nicholson G, Clabby M, Mahle W (2014) Is there a benefit to postoperative fluid restriction following infant surgery? Congenital Heart Dis 9(6):529–535CrossRefGoogle Scholar
  14. 14.
    Mehta NM, Christopher PD (2009) Nutritional deficiencies during critical illness. Pediatr Clin N A 56(5): 1143–1160CrossRefGoogle Scholar
  15. 15.
    Schwalbe-Terilli C, Hartman D, Nagle M, Gallagher P, Ittenbach R, Burnham N et al (2009) Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 18(1):52–57CrossRefGoogle Scholar
  16. 16.
    Togănel R (2013) Nutritional approach of pediatric patients diagnosed with congenital heart disease Acta Medica Marisiensis 59:2CrossRefGoogle Scholar
  17. 17.
    Wessner S, Burjonrappa S (2014) Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes? J Pediatr Surg 49(5):823–830CrossRefGoogle Scholar
  18. 18.
    Bharadwaj S, Ginoya S, Tandon P, Gohel T, Guirguis J, Vallabh H et al (2016) Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep 4:272–280Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Cardiac Intensive Care DivisionHarapan Kita National Cardiovascular CenterSlipiIndonesia

Personalised recommendations