Published online July 5, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e294-e299 (doi:10.1542/peds.2009-0141)
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ARTICLE

What Determines Nutritional Recovery in Malnourished Children After Correction of Congenital Heart Defects?

Balu Vaidyanathan, DMa, Reshma Radhakrishnan, MPHa, Deepa Aravindakshan Sarala, MSWa, Karimassery Ramaiyar Sundaram, PhDb and Raman Krishna Kumar, DM, FACCa

Departments of a Pediatric Cardiology
b Biostatistics, Amrita Institute of Medical Sciences and Research Center, Elamakkara, Kochi, Kerala, India

BACKGROUND: Malnutrition is common in children with congenital heart disease (CHD), especially in developing countries.

OBJECTIVE: To examine the impact of corrective intervention on the nutritional status of children with CHD and identify factors associated with suboptimal recovery.

METHODS: Consecutive patients with CHD in a tertiary center in South India were evaluated for nutritional status before and 2 years after corrective intervention. Anthropometry was performed at presentation and every 6 months for 2 years, and z scores were compared. Malnutrition was defined as a weight-for-age, height-for-age, and weight/height z score <–2. Determinants of malnutrition were entered into a multivariate logistic regression analysis model.

RESULTS: Of 476 patients undergoing corrective intervention (surgical: 344; catheter-based: 132) z scores of less than –2 for weight for age, height for age, and weight/height were recorded in 59%, 26.3%, and 55.9% of patients, respectively, at presentation. On follow-up (425 patients [92.5% of survivors; 20.63 ± 13.1 months of age]), z scores for weight for age and weight/height improved significantly from the baseline (weight: –1.42 ± 1.03 vs –2.19 ± 1.16; P < .001; weight/height: –1.15 ± 1.25 vs –2.09 ± 1.3; P < .001). Height-for-age z scores were not significantly different. Malnutrition persisted in 116 (27.3%) patients on follow-up and was associated with a birth weight of ≤2.5 kg, nutritional status at presentation, and height of parents and not with type of cardiac lesion, dietary intake, or socioeconomic factors.

CONCLUSIONS: This study from South India demonstrates severe malnutrition in over half of the patients with CHD and is not always reversed by corrective surgery or intervention. Persistent malnutrition after corrective intervention is predicted by nutritional status at presentation, birth weight, and parental anthropometry.

Key Words: congenital heart disease • malnutrition • corrective intervention

Abbreviations: CHD—congenital heart disease • CHF—congestive heart failure • CDC—Centers for Disease Control and Prevention

Accepted Mar 16, 2009.


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