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Published on: May 26, 2023
The Associations Between Preoperative Anthropometry and Postoperative Outcomes in Infants Undergoing Congenital Heart
Jia Yi Joel Lim1, Rui Wen Bryan Wee1, Mihir Gandhi2,3,4
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Insights
Low preoperative weight-for-age z-score (WAZ) in infants with congenital heart disease (CHD) is linked to higher risks of postoperative complications and 6-month mortality after cardiac surgery. Addressing malnutrition is crucial for improving outcomes in these vulnerable infants.
Area of Science:
- Pediatric Cardiology
- Surgical Outcomes Research
- Nutritional Science
Background:
- Infants with congenital heart disease (CHD) frequently experience feeding difficulties and malnutrition, impacting their surgical outcomes.
- Preoperative nutritional status is a critical factor in the recovery and survival of infants undergoing cardiac surgery.
Purpose of the Study:
- To investigate the association between preoperative anthropometric and biochemical markers and postoperative outcomes in infants with CHD.
- To identify specific nutritional indicators that predict complications and mortality following congenital heart surgery.
Main Methods:
- Retrospective review of infants (≤1 year) undergoing congenital heart surgery.
- Evaluation of preoperative weight-for-age z-score (WAZ), length-for-age z-score (LAZ), serum albumin, and hemoglobin.
- Statistical analysis using logistic and median regression models to assess outcomes like 6-month mortality and postoperative complications.
Main Results:
- Over 50% of infants had feeding difficulties preoperatively, with 21.6% requiring tube feeding.
- Low preoperative WAZ was significantly associated with an increased risk of postoperative complications (OR 1.82, p=0.02).
- Low preoperative WAZ also correlated with a higher risk of 6-month mortality (OR 2.38, p=0.008).
Conclusions:
- Preoperative malnutrition, indicated by low WAZ, is a significant predictor of adverse outcomes in infants undergoing cardiac surgery for CHD.
- Early nutritional assessment and intervention are vital for improving survival and reducing complications in this patient population.
Aim:
We explored the association between preoperative anthropometry and biochemistry, and postoperative outcomes in infants with CHD after cardiac surgery, as infants with congenital heart disease (CHD) often have feeding difficulties and malnutrition.
Methodology:
This was a retrospective review of infants (≤ 1-year-old) who underwent congenital heart surgery. Preoperative anthropometryin terms of preoperative weight-for-age z-score (WAZ), length-for-age z-score (LAZ), as well as preoperative serum albumin and hemoglobin concentrations, were evaluated against 6-month mortality, and morbidity outcomes including postoperative complications, vasoactive inotrope score, duration of mechanical ventilation, length of stay in the pediatric intensive care unit and in hospital, using the logistic regression or median regression models accounting for infant-level clustering.
Results:
One hundred and ninety-nine operations were performed in 167 infants. Mean gestational age at birth was 38.0 (SD 2.2) weeks (range 26 to 41 weeks). Thirty (18.0%) infants were born preterm (<37 weeks). The commonest acyanotic and cyanotic lesions were ventricular septal defect (26.3%, 44/167), and tetralogy of Fallot (13.8%, 23/167), respectively. Mean age at cardiac surgery was 94 (SD 95) days. Feeding difficulties, including increased work of breathing during feeding, diaphoresis, choking or coughing during feeding, and inability to complete feeds, was present in 54.3% (108/199) of infants prior to surgery, of which 21.6% (43/199) required tube feeding. The mean preoperative WAZ was-1.31 (SD 1.79). Logistic regression models showed that low preoperative WAZ was associated with increased risk of postoperative complications (odds ratio 1.82; p = 0.02), and 6-month mortality (odds ratio 2.38; p = 0.008) following CHD surgery. There was no meaningful association between the other preoperative variables and other outcomes.
Conclusion:
More than 50% of infants with CHD undergoing cardiac surgery within the first year of life have feeding difficulties, of which 22% require to be tube-fed. Low preoperative WAZ is associated with increased postoperative complications and 6-month mortality.
