Perioperative nutritional support and malnutrition in infants and children with congenital heart disease
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Benjamin J Toole1, Lindsay E Toole, Ursula G Kyle
1Division of Cardiology and Congenital Heart Surgery, Department of Pediatrics, Baylor College of Medicine, Houston, Tex, USA.
Insights
Malnutrition significantly impacts hospital outcomes in infants and children undergoing congenital heart surgery. Optimizing nutritional status before and after surgery is crucial for improving recovery and reducing complications.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care
- Nutritional Science
Background:
- Congenital heart disease (CHD) surgery in infants and children is complex and associated with significant morbidity.
- Nutritional status is a critical determinant of patient outcomes, particularly in critically ill pediatric populations.
- Cardiovascular risk factors can influence surgical outcomes in young patients with CHD.
Purpose of the Study:
- To evaluate the impact of nutritional status on hospital outcomes following congenital heart surgery in pediatric patients.
- To assess the relationship between cardiovascular risk factors and outcomes in infants and children undergoing CHD surgery.
- To identify key factors influencing recovery and length of stay in the cardiovascular intensive care unit (CVICU).
Main Methods:
- Retrospective study of 121 infants and children (<24 months) admitted to a CVICU post-cardiac surgery.
- Data collected included demographics, surgical risk scores (RACHS-1, PIM2, POMIII), and nutritional intake for 7 days.
- Malnutrition was assessed using Waterlow criteria, and outcomes analyzed included mortality, ventilation duration, and hospital/CVICU length of stay.
Main Results:
- Patients with higher surgical risk scores (RACHS-1 4-6) exhibited increased mortality risk, longer CVICU and hospital stays, and more mechanical ventilation days.
- Prevalence of acute and chronic protein-energy malnutrition was high (51.2% and 40.5%, respectively).
- Malnutrition was associated with significantly longer hospital stays, with severe chronic malnutrition leading to the longest durations.
Conclusions:
- A significant proportion of pediatric patients undergoing CHD surgery are malnourished, receiving only two-thirds of recommended nutritional intake in the first week.
- Optimizing nutritional status pre- and post-operatively is essential for improving hospital outcomes in infants and children with congenital heart disease.
- Addressing malnutrition is a key strategy to mitigate risks and enhance recovery following complex cardiac surgery in pediatric populations.
Objective:
To assess the effect of nutritional status and cardiovascular risk on hospital outcomes after congenital heart surgery in infants and children.
Design:
Retrospective study.
Setting:
Cardiac intensive care unit in a tertiary-care children's hospital.
Patients:
One hundred twenty-one patients <24 months of age admitted to the cardiovascular intensive care unit (CVICU) for >48 hours following cardiac surgery.
Methods:
Demographics, Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), Paediatric Index of Mortality 2, and Pediatric Risk of Mortality III scores were obtained on admission. CVICU nutritional intake was calculated for 7 days. Energy and protein needs were estimated using recommended guidelines. Risk Adjustment for Congenital Heart Surgery-1 was categorized as (1-3) or (4-6). Malnutrition was categorized by Waterlow criteria and correlated with mortality risk, days of mechanical ventilation, and hospital and CVICU length of stay.
Results:
Ninety-one patients who underwent cardiac surgery were categorized as RACHS-1 (1-3) and RACHS-1 scores of (4-6) (n = 30). Patients with RACHS-1 (4-6) had higher mortality risk by Pediatric Risk of Mortality III (4.9% vs. 2.6%, P < .01), longer CVICU (10.4 days vs. 4.8 days) and hospital stays (28 days vs.14 days), and more days of mechanical ventilation (4 days vs. 2 days) (all P < .005) than RACHS-1 (1-3). The prevalences of acute protein-energy malnutrition and chronic protein-energy malnutrition were 51.2% and 40.5%. The median hospital stay for mild, moderate, and severe chronic protein-energy malnutrition was 31, 10, and 22.5 days, respectively, vs. normal, 15 days (Kruskal-Wallis, P < .005). The average energy and protein requirements met on day 7 were 68 ± 27(SD)% and 68 ± 40%, respectively.
Conclusion:
Although nearly half of the patients were malnourished at surgery, only two-thirds of their recommended caloric and protein requirements were provided by week 1. To improve hospital outcomes, care should be taken to optimize the nutritional condition of infants and children prior to and following surgical correction of congenital heart disease to improve hospital outcomes.
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