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Impaired weight gain predicts risk of late death after surgery for congenital heart defects
L T Eskedal1, P S Hagemo, E Seem
1Department of Paediatrics, Sørlandet Regional Hospital, Kristiansand, Norway. leif.eskedal@sshf.no
Insights
A significant drop in weight for age after congenital heart defect surgery strongly predicts late mortality in children. Monitoring weight gain post-surgery is crucial for assessing survival risk.
Area of Science:
- Pediatric Cardiology
- Surgical Outcomes
- Growth Monitoring
Background:
- Congenital heart defects (CHDs) are common birth anomalies requiring surgical intervention.
- Long-term somatic growth and its impact on survival after CHD surgery are not fully understood.
- Late mortality after CHD surgery necessitates investigation into predictive factors.
Purpose of the Study:
- To evaluate long-term weight-for-age growth in children undergoing surgery for CHDs who experience late mortality.
- To determine the association between postoperative weight changes and survival rates in pediatric CHD patients.
Main Methods:
- A nested case-control study involving children born between 1990-2002 who died late post-CHD surgery.
- Weight data analyzed using z-scores at birth, last operation, and last recorded weight.
- Cases (children who died late) compared with matched surviving controls with similar surgical complexity.
Main Results:
- Children who died late showed significantly lower weight-for-age z-scores post-surgery compared to controls.
- A decrease in weight z-score exceeding 0.67 after the last operation was strongly associated with increased odds of death (OR 13.5).
- Median follow-up was 5.7 months.
Conclusions:
- A decline in weight-for-age z-scores by more than 0.67 in the initial months after CHD surgery is a significant predictor of late mortality.
- This finding highlights the importance of monitoring growth trajectories in pediatric patients post-CHD repair.
Objectives:
To describe long-term somatic growth in terms of weight for age in children operated on for congenital heart defects who die late (after the first 30 postoperative days) and to study the relationship between postoperative weight gain and survival after surgery for congenital heart defects.
Methods:
This was a nested case-control study of 80 children born in 1990-2002 who died late after surgery for congenital heart defects at Rikshospitalet, Norway. Weight data were obtained for 74 children, of whom 31 with no extra-cardiac anomalies were defined as cases and 31 surviving children with similar surgical complexity were defined as controls.
Results:
In the 74 children who died late, mean weight for age converted to z scores at birth, at last operation and at last recorded weight were 0.12, -1.31 and -2.09. In the 31 children defined as cases, the same weight z scores were 0.07, -1.21 and -2.01 compared with 0.05, -1.10 and -0.99 in the 31 matched controls. The odds ratio (OR) for death was 13.5 (95% CI 3.6 to 51.0) if there was a decrease in weight z score of >0.67 after the last operation. Median follow-up time after operation was 5.7 months.
Conclusions:
A decrease in weight for age during the first months after surgery for congenital heart defects of more than 0.67 z scores, corresponding to a downward percentile crossing through at least one of the displayed percentile lines on standard growth charts, is strongly related to late mortality in children operated on for congenital heart defects.
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