Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

Mohammad Abdallah Khasawneh, Ashraf Fadel Mohammad, Safwan G. Al-Fawares, Odai Almomani, Fadi Al-Husban


Background: To identify the prevalence, predictors and implications of malnutrition and failure to thrive (FTT) in paediatric cardiac surgical patients.

Methods: Observational retrospective analysis of data of paediatric patients presenting for cardiac surgery at Queen Alia heart institute/Amman/Jordan between April 2020 and October 2020. Patients' ages, anthropometric measurements, diagnoses, type of surgical intervention, ICU stay and perioperative outcomes were recorded on a special form designed for the purpose of this study. Prevalence of malnutrition based on world health organization (WHO) and centers for disease control (CDC) growth charts was determined using height-for-age z-score (HAZ) and percentile, weight-for-age z-score (WAZ) and percentile, weight-for-height z-score (WHZ) and percentile. BMI was used for patients above 2 years of age in 109 paediatric cardiac surgical patients. Prevalence of malnutrition and FTT was examined according to age category and cardiac pathology). Patients were divided according to heart pathology into cyanotic and acyanotic CHD.

Results: One hundred and nine pediatric cardiac surgical patients were presented for cardiac surgery (59 males and 50 females). Patients' age ranged from 2 days to 17 years (mean 3.7 years, SD±4.5 years). Patients' body weight ranged from 2.7 to 70 kg (mean 14.98 kg, SD±14.2 kg). Average weight percentile was 19.26 (SD±20.01) and ranged between 0.1 and 88.5 and the average Z-score for weight was -1.274±1.037 (mean±SD). The overall height percentile for the all patients with CHD averaged 18.53±17.1 (mean±SD) and the average Z-score for height was -1.1029±0.743 (mean±SD). Prevalence of isolated malnutrition and FTT was 33.2% and 20.2%. Normal nutritional status was found in 46.78%. Cyanotic type CHD was more commonly associated with FTT (p=0.001), longer cardiopulmonary bypass (p=0.001), higher intraoperative lactate (p=0.012) and aortic cross clamp times (p=0.001). Patients with malnutrition and FTT had average ICU stay of 4.32±2.219 days and averaged 4.772±2.065 days (mean±SD) respectively, which was almost double of the ICU stay of patients who had normal nutritional status 2.32±2.261 days (mean±SD).

Conclusions: Prevalence of malnutrition and FTT is high in paediatric patients with CHD at time of presentation for surgery. Predicting factors for malnutrition and FTT are cyanotic type of CHD and smaller age. Malnutrition was associated with longer ICU stay.


Congenital, Cyanotic, FFT, Heart, Intensive care, Malnutrition

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Wu W, He J, Shao X. Incidence and mortality trend of congenital heart disease at the global, regional, and national level, 1990-2017. Medicine (Baltimore). 2020;99(23):e20593.

GBD 2017 Congenital Heart Disease Collaborators. Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health. 2020;4(3):185-200.

Batte A, Lwabi P, Lubega S. Wasting, underweight and stunting among children with congenital heart disease presenting at Mulago hospital, Uganda. BMC Pediatr. 2017;17(1):10.

Daymont C, Neal A, Prosnitz A, Cohen MS. Growth in children with congenital heart disease. Pediatrics. 2013;131(1):e236-42.

Van der Kuip M, Hoos MB, Forget PP, Westerterp KR, Gemke RJ, De Meer K. Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr. 2003;92(8):921-7.

Nydegger A, Walsh A, Penny DJ, Henning R, Bines JE. Changes in resting energy expenditure in children with congenital heart disease. Eur J Clin Nutr. 2009;63(3):392-7.

Forchielli ML, McColl R, Walker WA, Lo C. Children with congenital heart disease: a nutrition challenge. Nutr Rev. 1994;52(10):348-53.

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(1):15-25.

Arodiwe I, Chinawa J, Ujunwa F, Adiele D, Ukoha M, Obidike E. Nutritional status of congenital heart disease (CHD) patients: Burden and determinant of malnutrition at university of Nigeria teaching hospital Ituku-Ozalla, Enugu. Pak J Med Sci. 2015;31(5):1140-45.

Mehta NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. 2009;56(5):1143-1160.

Steward DK, Ryan-Wenger NA, Boyne LJ. Selection of growth parameters to define failure to thrive. J Pediatr Nurs. 2003;18(1):52-9.

Menon G, Poskitt EM. Why does congenital heart disease cause failure to thrive? Arch Dis Child. 1985;60(12):1134-1139.

Grummer-Strawn LM, Reinold C, Krebs NF; Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep. 2010;59(RR-9):1-15.

Schwarz NG, Grobusch MP, Decker ML, Goesch J, Poetschke M, Oyakhirome S et al. WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references. Public Health Nutr. 2008;11(7):714-9.

Weidauer L, Wey H, Slater H, Moyer-Mileur L, Specker B. Estimation of length or height in infants and young children using ulnar and lower leg length with dual-energy X-ray absorptiometry validation. Dev Med Child Neurol. 2014;56(10):995-1000.

Argent A, Balachandran R, Vaidyanathan B, Khan A, Kumar R. Management of undernutrition and failure to thrive in children with congenital heart disease in low-and middle-income countries. Cardiol Young. 2017;27(S6):S22-30.

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(3):S133-7.

Wright CM. Identification and management of failure to thrive: a community perspective. Arch Dis Child. 2000;82(1):5-9.

Costello CL, Gellatly M, Daniel J, Justo RN, Weir K. Growth Restriction in Infants and Young Children with Congenital Heart Disease. Congenit Heart Dis. 2015;10(5):447-56.

Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A et al. 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 Thorac Cardiovasc Surg. 2014;147(1):442-50.

Britt S, Lie T, Monique R, Titus C. Prevalence and impact of malnutrition among children undergoing congenital heart surgery. Critical Care Med. 2019;47(1):106.

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(1):15-25.

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;15;3:53.

Zhang M, Wang L, Huang R. Risk factors of malnutrition in Chinese children with congenital heart defect. BMC Pediatr. 2020;20:213.

Ross E, Munoz FM, Edem B. Failure to thrive: Case definition and guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. 2017;35(48 Pt A):6483-91.

Tabib A, Aryafar M, Ghadrdoost B. Prevalence of Malnutrition in Children with Congenital Heart Disease, J Compr Ped. 2020;10(4):e84274.

Ulfah D, Lestari E, Salimo H, Widjaya S, Artiko B. The effect of cyanotic and acyanotic congenital heart disease on children’s growth velocity. PI. 2021;57(3):160.

Jaime SG, Lara S, Saul F, Nancy G, Jeramy R, Jorge CB. Malnutrition and postoperative outcomes in pediatric patients with congenital heart disease. Critical Care Med. 2019;47(1):105.

Ross F, Latham G, Joffe D. Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery. Cardiol Young. 2017;27(9):1716-25.

Tsintoni A, Dimitriou G, Karatza AA. Nutrition of neonates with congenital heart disease: existing evidence, conflicts and concerns. J Matern Fetal Neonatal Med. 2020;33(14):2487-92.

Mangili G, Garzoli E, Sadou Y. Feeding dysfunctions and failure to thrive in neonates with congenital heart diseases. Pediatr Med Chir. 2018;23;40(1).

Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease: a challenge in children. Curr Opin Cardiol. 2013;28(2):122-9.