Pre-operative nutritional status and its association with short-term post-operative outcomes in Iranian children with
Maryam Aryafar1, Mohammad Mahdavi2, Hossein Shahzadi2
1Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Pre-operative nutritional status in children with congenital heart disease (CHD) impacts surgical outcomes. Low mid-upper arm circumference and serum protein predict longer ICU stays and ventilation, guiding perioperative nutrition.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Cardiology
Background:
- Nutritional status is crucial for children with congenital heart disease (CHD) undergoing surgery.
- Malnutrition can increase morbidity associated with corrective surgery.
Purpose of the Study:
- To assess the impact of pre-operative nutritional status on short-term outcomes in children undergoing CHD surgery.
- To identify nutritional parameters that predict post-operative complications.
Main Methods:
- Prospective single-center cohort study of 120 children (6-24 months) undergoing CHD surgery.
- Excluded were premature, low birthweight, or genetically syndromic infants.
- Pre-operative anthropometrics and serum levels (total protein, vitamin D, iron, ferritin) were measured.
Main Results:
- Over half of patients had reduced weight-for-age z-scores (50.8%) and nearly 60% had reduced mid-upper arm circumference (MUAC) z-scores (≤-2.0).
- Low serum protein was linked to longer ICU stay and mechanical ventilation.
- Low MUAC z-score predicted longer ICU stay, mechanical ventilation, and inotrope duration.
Conclusions:
- Pre-operative anthropometric (MUAC z-score) and biochemical (serum protein) assessments are valuable predictors of short-term outcomes in pediatric CHD surgery.
- These nutritional markers can guide perioperative nutritional interventions for at-risk children.
Background:
Nutritional assessment appears to be an essential component of the evaluation of children with CHD undergoing surgery because nutritional status may impact corrective surgery-associated morbidity.
Methods:
A prospective single-centre cohort study with children between 6 and 24 months of age. Patients who had genetic syndromes or those who were premature or low birthweight at birth were excluded. Pre-operative nutritional parameters included anthropometric measurements and serum concentrations of total protein, vitamin D, iron, and ferritin. Outcome measures included ICU length of stay, mechanical ventilation, vasoactive-inotropic score, and duration of inotropes. Linear regression analysis was performed to determine whether pre-operative variables were associated with outcomes.
Results:
Analysis was performed on 120 patients (median age of 8 months), of whom 67 were male. Prior to surgery, 50.8% of patients had reduced (z ≤ -2.0) weight-for-age z score, 23.3% had reduced length-for-age z score, and 59.2% had reduced mid-upper arm circumference z score. Pre-operative serum total protein levels were 59.36 ± 9.16 g/L. Multiple regression analysis showed that low serum protein was associated with longer ICU length of stay and length of mechanical ventilation, while mid-upper arm circumference z score ≤ -2 was associated with longer ICU length of stay and mechanical ventilation and inotropes duration.
Conclusions:
Pre-operative assessment of nutritional status by performing anthropometric and biochemical measurements including mid-upper arm circumference z score and serum protein concentrations in children undergoing CHD surgery appears to be predictors of some post-operative short-term outcomes and could be used as a guide to highlight patients needing appropriate perioperative nutritional interventions.
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