Risk Factors Affecting the Length of Improvement of Nutritional Status in Children with Congenital Heart Disease and Malnutrition

Authors

  • Athiyatul Aufie Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Sukman Tulus Putra Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Mulya Rahma Karyanti Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Yoga Devaera Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.2.1.2023.16-26

Keywords:

Congenital heart disease, duration, improvement, malnutrition, risk factor

Abstract

Background: To date, limited data are available regarding the factors that contribute to the delay of improvement in nutritional status as well as data regarding the optimal duration to improve malnutrition among children with congenital heart disease (CHD). Such data are important for pediatricians to fully optimize the nutritional status for those children prior to surgical procedure This study aims to identify those aforementioned factors in hope for better surgical outcome and quality of life of children with CHD.

Methods: This is a descriptive analytic study using retrospective cohort design to identify the factors that contribute to the delay of improvement in nutritional status among children with CHD. Variables such as the type of CHD, classification of CHD complexity, pulmonary hypertension, heart failure, corrective surgery, the route of nutrition access, pneumonia, diarrhea, special diets and patients undergoing routine control at the nutrition outpatient clinic were evaluated in this study.

Results: A total of 216 children with a diagnosis of CHD and weight-for-length z-score under -1 SD were included in this study. Based on multivariate analysis, there were two significant risk factors, which were the occurrence of diarrhea and consulting at nutrition outpatient clinic. The improvement in nutritional status in children with CHD who did not have diarrhea was faster than those with diarrhea (HR 1.94; 95% CI 1.10 – 3.47) (p value <0.025). Improvement in nutritional status of those children that underwent control at the nutrition outpatient clinic was faster than those who did not (HR 1.87; 95% CI 1.20 – 2.92) (p value <0.006).

Conclusion: Risk factors that significantly lengthen the duration of improvement in the nutritional status of CHD patients were the incidence of diarrhea and those who did not undergo control at the nutrition outpatient clinic.

References

Hassan BA, Albanna EA, Morsy SM, Siam AG, Al Shafie MM, Elsaadany HF, et al. Nutritional Status in Children with Un-Operated Congenital Heart Disease: An Egyptian Center Experience. Front Pediatr. 2015;3:53.https://doi.org/10.3389/fped.2015.00053

Amelia P, Adriansyah R, Lubis B, Akil M. The Association between Cyanotic and Acyanotic Congenital Heart Disease with Nutritional Status. Open Access Macedonian Journal of Medical Sciences. 2020;8(B):245-8.https://doi.org/10.3889/oamjms.2020.3978

Rubia B, Kher A. Anthropometric assessment in children with congenital heart disease. 2018. 2018;5(2):6.https://doi.org/10.18203/2349-3291.ijcp20180569

Blasquez A, Clouzeau H, Fayon M, Mouton JB, Thambo JB, Enaud R, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr. 2016;70(4):528-31.https://doi.org/10.1038/ejcn.2015.209

Schlaudecker EP, Steinhoff MC, Moore SR. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Curr Opin Infect Dis. 2011;24(5):496-502.https://doi.org/10.1097/QCO.0b013e328349287d

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:S133-7

Dr Swagata M, Dr Joy Liston Pratap DS. Anthropometric profiles of children with congenital heart disease. Pediatric Review: International Journal of Pediatric Research. 2016;3(8).https://doi.org/10.17511/ijpr.2016.i08.05

Zhang M, Wang L, Huang R, Sun C, Bao N, Xu Z. Risk factors of malnutrition in Chinese children with congenital heart defect. BMC Pediatrics. 2020;20(1):213.https://doi.org/10.1186/s12887-020-02124-7

Mitting R, Marino L, Macrae D, Shastri N, Meyer R, Pathan N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med. 2015;16(5):448-52. https://doi.org/10.1097/pcc.0000000000000402

Devaera Y, Kuswiyanto RB, Andriastuti M. Anthropometric assessment parameters in children with disease-related malnutrition. Asian Pacific Journal of Pediatrics and Child Health. March 2022;5.

Ferdous F, Das SK, Ahmed S, Farzana FD, Latham JR, Chisti MJ, et al. Severity of diarrhea and malnutrition among under five-year-old children in rural Bangladesh. Am J Trop Med Hyg. 2013;89(2):223-8.https://doi.org/10.4269/ajtmh.12-0743

Kane AV, Dinh DM, Ward HD. Childhood malnutrition and the intestinal microbiome. Pediatr Res. 2015;77(1-2):256-62.https://doi.org/10.1038/pr.2014.179

Ellis CL, Rutledge JC, Underwood MA. Intestinal microbiota and blue baby syndrome: probiotic therapy for term neonates with cyanotic congenital heart disease. Gut Microbes. 2010;1(6):359-66.https://doi.org/10.4161/gmic.1.6.14077

Subramanian S, Huq S, Yatsunenko T, Haque R, Mahfuz M, Alam MA, et al. Persistent gut microbiota immaturity in malnourished Bangladeshi children. Nature. 2014;510(7505):417-21.https://doi.org/10.1038/nature13421

Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204

Kerac M, Bunn J, Seal A, Thindwa M, Tomkins A, Sadler K, et al. Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi. Lancet. 2009;374(9684):136-44.https://doi.org/10.1016/s0140-6736(09)60884-9

Argent AC, Balachandran R, Vaidyanathan B, Khan A, Kumar RK. Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries. Cardiol Young. 2017;27(S6):S22-s30.https://doi.org/10.1017/s104795111700258x

Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease: a challenge in children. Curr Opin Cardiol. 2013;28(2):122-9.https://doi.org/10.1097/HCO.0b013e32835dd005

Hehir DA, Ghanayem NS. Single-ventricle infant home monitoring programs: outcomes and impact. Curr Opin Cardiol. 2013;28(2):97-102.https://doi.org/10.1097/HCO.0b013e32835dceaf

Cameron JW, Rosenthal A, Olson AD. Malnutrition in hospitalized children with congenital heart disease. Archives of pediatrics & adolescent medicine. 1995;149(10):1098-102. https://doi.org/10.1001/archpedi.1995.02170230052007

Prasadajudio M, Devaera Y, Noormanto N, Kuswiyanto RB, Sudarmanto B, Andriastuti M, et al. Disease-Related Malnutrition in Pediatric Patients with Chronic Disease: A Developing Country Perspective. Current Developments in Nutrition. 2022:100021.https://doi.org/10.1016/j.cdnut.2022.100021

Ross F, Latham G, Joffe D, Richards M, Geiduschek J, Eisses M, et al. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiology in the Young. 2017;27(9):1716-25. https://doi.org/10.1017/S1047951117001068

Cognata A, Kataria-Hale J, Griffiths P, Maskatia S, Rios D, O'Donnell A, et al. Human milk use in the preoperative period is associated with a lower risk for necrotizing enterocolitis in neonates with complex congenital heart disease. The Journal of pediatrics. 2019;215:11-6. e2. https://doi.org/10.1016/j.jpeds.2019.08.009

Herridge J, Tedesco-Bruce A, Gray S, Floh AA. Feeding the child with congenital heart disease: a narrative review. Pediatr Med. 2021;4(0). https://doi.org/10.21037/pm-20-77

Published

2023-02-28

How to Cite

1.
Risk Factors Affecting the Length of Improvement of Nutritional Status in Children with Congenital Heart Disease and Malnutrition. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2023 Feb. 28 [cited 2024 Dec. 3];2(1):16-2. Available from: https://apghn.com/index.php/journal/article/view/34