Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T07:21:06.091Z Has data issue: false hasContentIssue false
  • English
  • Français

Preoperative malnutrition is associated with increased mortality and adverse outcomes after paediatric cardiac surgery

Published online by Cambridge University Press:  19 June 2017

Faith Ross Open the ORCID record for Faith Ross [Opens in a new window] ,
Gregory Latham ,
Denise Joffe ,
Michael Richards ,
Jeremy Geiduschek ,
Michael Eisses ,
Douglas Thompson  and
Monique Radman
Faith Ross*
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Gregory Latham
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Denise Joffe
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Michael Richards
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Jeremy Geiduschek
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Michael Eisses
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Douglas Thompson
Affiliation:
Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
Monique Radman
Affiliation:
Critical Care, Seattle Children’s Hospital, University of Washington, Seattle, Washington, United States of America
*
Correspondence to: F. Ross, MD, Anesthesiology and Pain Medicine, 4800 Sandpoint Way NE MB.11.500, Seattle, WA 98105, United States of America. Tel: (206) 987-3996; Fax: (206) 987-3935; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery.

Methods

We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children’s Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes.

Results

We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ⩽−2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay.

Conclusions

This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality.

Keywords

NutritionmalnutritionCHDcongenital cardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1716 - 1725
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Approved by the Seattle Children’s Hospital IRB on 12 February, 2016.

References

1. Chen, LC, Chowdhury, A, Huffman, SL. Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children. Am J Clin Nutr 1980; 33: 1836–1845.Google Scholar
2. Mehta, NM, Corkins, MR, Lyman, B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. J Parenter Enteral Nutr 2013; 37: 460–481.Google Scholar
3. Victora, CG. The association between wasting and stunting: an international perspective. J Nutr 1992; 122: 1105–1110.CrossRefGoogle ScholarPubMed
4. Pollack, MM, Ruttimann, UE, Wiley, JS. Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care. J Parenter Enteral Nutr 1985; 9: 309–313.CrossRefGoogle ScholarPubMed
5. Grippa, RB, Silva, PS, Barbosa, E, Bresolin, NL, Mehta, NM, Moreno, YM. Nutritional status as a predictor of duration of mechanical ventilation in critically ill children. Nutrition 2017; 33: 91–95.Google Scholar
6. Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med 2015; 16: 448–452.Google Scholar
7. Radman, M, Mack, R, Barnoya, J, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg 2014; 147: 442–450.Google Scholar
8. Toole, BJ, Toole, LE, Kyle, UG, Cabrera, AG, Orellana, RA, Coss-Bu, JA. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis 2014; 9: 15–25.CrossRefGoogle ScholarPubMed
9. Wong, JJ, Cheifetz, IM, Ong, C, Nakao, M, Lee, JH. Nutrition support for children undergoing congenital heart surgeries: a narrative review. World J Pediatr Congenit Heart Surg 2015; 6: 443–454.CrossRefGoogle ScholarPubMed
10. Burch, PT, Ravishankar, C, Newburger, JW, et al. Assessment of growth 6 years after the Norwood procedure. J Pediatr 2017; 180: 270–274.e6.Google Scholar
11. Jackson, M, Poskitt, EM. The effects of high-energy feeding on energy balance and growth in infants with congenital heart disease and failure to thrive. Br J Nutr 1991; 65: 131–143.Google Scholar
12. Blasquez, A, Clouzeau, H, Fayon, M, et al. Evaluation of nutritional status and support in children with congenital heart disease. Eur J Clin Nutr 2016; 70: 528–531.Google Scholar
13. Cameron, JW, Rosenthal, A, Olson, AD. Malnutrition in hospitalized children with congenital heart disease. Arch Pediatr Adolesc Med 1995; 149: 1098–1102.Google Scholar
14. Hassan, BA, Albanna, EA, Morsy, SM, et al. Nutritional status in children with un-operated congenital heart disease: an Egyptian center experience. Front Pediatr 2015; 3: 53.CrossRefGoogle ScholarPubMed
15. Varan, B, Tokel, K, Yilmaz, G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 1999; 81: 49–52.Google Scholar
16. Krauss, AN, Auld, PA. Metabolic rate of neonates with congenital heart disease. Arch Dis Child 1975; 50: 539–541.Google Scholar
17. Barton, JS, Hindmarsh, PC, Scrimgeour, CM, Rennie, MJ, Preece, MA. Energy expenditure in congenital heart disease. Arch Dis Child 1994; 70: 5–9.CrossRefGoogle ScholarPubMed
18. Hansen, SR, Dorup, I. Energy and nutrient intakes in congenital heart disease. Acta Paediatr 1993; 82: 166–172.Google Scholar
19. Mehta, NM, Duggan, CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am 2009; 56: 1143–1160.CrossRefGoogle ScholarPubMed
20. Schwarz, SM, Gewitz, MH, See, CC, et al. Enteral nutrition in infants with congenital heart disease and growth failure. Pediatrics 1990; 86: 368–373.Google Scholar
21. Sondheimer, JM, Hamilton, JR. Intestinal function in infants with severe congenital heart disease. J Pediatr 1978; 92: 572–578.Google Scholar
22. Milne, E, Elliott, M, Pearson, D, Holden, M, Orskov, H, Alberti, K. The effect on intermediary metabolism of open-heart surgery with deep hypothermia and circulatory arrest in infants of less than 10 kilograms body weight. A preliminary study. Perfusion 1986; 1: 29–40.Google Scholar
23. Hong, BJ, Moffett, B, Payne, W, Rich, S, Ocampo, EC, Petit, CJ. Impact of postoperative nutrition on weight gain in infants with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2014; 147: 1319–1325.Google Scholar
24. Mehta, NM, Bechard, LJ, Cahill, N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children – an international multicenter cohort study*. Critical Care Med 2012; 40: 2204–2211.Google Scholar
25. Schwalbe-Terilli, CR, Hartman, DH, Nagle, ML, et al. Enteral feeding and caloric intake in neonates after cardiac surgery. Am J Crit Care 2009; 18: 52–57.Google Scholar
26. Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397–404.e1.Google Scholar
27. Anderson, JB, Kalkwarf, HJ, Kehl, JE, Eghtesady, P, Marino, BS. Low weight-for-age z-score and infection risk after the Fontan procedure. Ann Thorac Surg 2011; 91: 1460–1466.Google Scholar
28. Wallace, MC, Jaggers, J, Li, JS, et al. Center variation in patient age and weight at Fontan operation and impact on postoperative outcomes. Ann Thorac Surg 2011; 91: 1445–1452.CrossRefGoogle ScholarPubMed
29. Larsen, BM, Goonewardene, LA, Field, CJ, et al. Low energy intakes are associated with adverse outcomes in infants after open heart surgery. J Parenter Enteral Nutr 2013; 37: 254–260.Google Scholar
30. Eskedal, LT, Hagemo, PS, Seem, E, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008; 93: 495–501.Google Scholar
31. Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–184.CrossRefGoogle ScholarPubMed
32. Malik, S, Cleves, MA, Zhao, W, Correa, A, Hobbs, CA, National Birth Defects Prevention Study. Association between congenital heart defects and small for gestational age. Pediatrics 2007; 119: e976–e982.Google Scholar
33. Sochet, AA, Ayers, M, Quezada, E, et al. The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease. Cardiol Young 2013; 23: 896–904.CrossRefGoogle ScholarPubMed
34. Lambert, LM, Pike, NA, Medoff-Cooper, B, et al. Variation in feeding practices following the Norwood procedure. J Pediatr 2014; 164: 237–242 e231.Google Scholar
35. Toms, R, Jackson, KW, Dabal, RJ, Reebals, CH, Alten, JA. Preoperative trophic feeds in neonates with hypoplastic left heart syndrome. Congenital Heart Dis 2015; 10: 36–42.Google Scholar
36. Edwards, JD, Rivanis, C, Kun, SS, Caughey, AB, Keens, TG. Costs of hospitalized ventilator-dependent children: differences between a ventilator ward and intensive care unit. Pediatr Pulmonol 2011; 46: 356–361.Google Scholar
Supplementary material: File

Ross supplementary material

Table S4

Download Ross supplementary material(File)
File 97.9 KB