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Postnatal growth in southern Chinese children with symptomatic congenital heart disease
E G Jacobs1, M P Leung, J P Karlberg
1Department of Paediatrics, The University of Hong Kong, Grantham Hospital, SAR, China.
Insights
Growth retardation is common in Chinese children with congenital heart disease (CHD). Acyanotic lesions and specific heart defects were linked to poorer growth outcomes, regardless of surgery timing.
Area of Science:
- Pediatrics
- Cardiology
- Growth and Development
Background:
- Congenital heart disease (CHD) is a significant health concern in children.
- Western studies indicate growth retardation is prevalent in pediatric CHD populations.
- Limited data exists on postnatal growth patterns in Chinese children with symptomatic CHD.
Purpose of the Study:
- To investigate postnatal growth in Chinese children with symptomatic CHD.
- To analyze growth in relation to specific cardiac diagnoses and surgical timing.
- To compare growth patterns between genders and lesion types (cyanotic vs. acyanotic).
Main Methods:
- Study included 363 Chinese children (≤4 years) admitted to Grantham Hospital, Hong Kong (1994-1995).
- Children were categorized into six diagnostic groups and further into cyanotic and acyanotic groups.
- Growth parameters (weight, height, weight-for-height) were assessed using standard deviation scores (SDS) relative to age and sex.
Main Results:
- Approximately 40% of children exhibited subnormal weight and height at surgery, despite only 18% having reduced birth weight SDS.
- Girls showed greater impairment in weight and weight-for-height compared to boys.
- Acyanotic lesions were associated with more significant growth issues than cyanotic lesions, with specific defects correlating to stunting or wasting.
Conclusions:
- Growth retardation is a common issue in Chinese children with symptomatic CHD, similar to Western cohorts.
- Hemodynamic factors and lesion type significantly impact growth, while age at operation showed no independent effect.
- Further research into hemodynamic, nutritional, and surgical timing influences is warranted to optimize growth outcomes.
Abstract:
Many Western children with congenital heart disease (CHD) show significant growth retardation. In this study postnatal growth was examined in Chinese children with symptomatic CHD in Hong Kong, in relation to their diagnosis and the time of surgery. 363 children of four years old or younger, who were admitted at Grantham Hospital, Hong Kong, in 1994 and 1995, were subdivided into six diagnostic categories and categorised into cyanotic and acyanotic groups. While a reduced birth weight SDS was present in 18% of patients, at the time of operation approximately 40% of them had subnormal weight and height values. Girls were more impaired in weight and weight-for-height than boys (-1.90 SDS vs -1.52 SDS, and -0.90 SDS vs -0.46 SDS, respectively). Children with acyanotic lesions were more affected in growth than those with cyanotic lesions, but they were also operated on at an older age than children in the latter group. Left to right shunt and common intracardiac mixing were particularly associated with wasting; transposition of the great arteries and pulmonary outflow tract obstruction with stunting; while children with left ventricular outflow obstruction revealed a proportional growth retardation in weight and height. Age at operation did not seem to have an independent effect on postnatal growth in children with CHD. As with Western children, growth retardation is a common feature in Chinese children with symptomatic cardiac defects. Haemodynamics, age at operation and nutritional influences are discussed as potential aetiologic factors.