Paediatrica Indonesiana (Apr 2015)

Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

  • Eva M. Marwali,
  • Sekarpramita Darmaputri,
  • Dadang H. Somasetia,
  • Sudigdo Sastroasmoro,
  • Nikolaus A. Haas,
  • Michael A. Portman

DOI
https://doi.org/10.14238/pi55.2.2015.109-16
Journal volume & issue
Vol. 55, no. 2
pp. 109 – 16

Abstract

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Background Most children undergoing cardiac surgery for congenital heart disease (CHD) in developing countries are malnourished. Malnutrition is known as a co-morbidity factor that might predict and influence outcomes after surgery. Objectives To evaluate the effect of malnutrition and other associated risk factors on post-operative outcomes in children with CHDs underwent cardiac surgery. Methods We conducted a retrospective cohort study in a single center tertiary pediatric cardiac intensive care unit (PCICU) in Indonesia. Our cohort included all children between 5 and 36 months of age undergoing congenital heart surgery with cardiopulmonary bypass from November 2011 until February 2014. Outcomes measured were the length of intubation and the length of ICU stay. Variables for potential influence investigated were the nutritional status, age, gender, type of cardiac anomaly (acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypass time, aortic cross-clamp time, and Pediatric Risk of Mortality (PRISM) III score. Results Out of 249 patients included, 147 (59%) showed malnourishment on admission. Malnourished patients were significantly younger in age, presented with an acyanotic heart defects, and had higher PRISM III score. Additionally, they also had a longer mechanical ventilation time and ICU stay than those with a normal nutritional status. After adjusting for various variables using a multiple logistic regression model it could be demonstrated that a higher Z-score for weight to age was a significant protective factor for the intubation time of more than 29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P = 0.012). Non-malnourished patients had a 49% significantly higher chance for extubation with a hazard ratio of 1.49 (95% CI 1.12 to 1.99, P= 0.007). Conclusion Malnourishment is clearly associated in a linear fashion with longer mechanical ventilation and ICU stay. As one of significant and potentially treatable co-morbidity factors, prevention of malnourishment by early diagnosis and optimal timing for surgery is important.

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