title: What determines nutritional recovery in malnourished children after correction of congenital heart defects?
abstract: 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 <or=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.
authors: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India. baluvaidyanathan@gmail.com
authors: Balu
authors: B
authors: Vaidyanathan
authors: Reshma
authors: R
authors: Radhakrishnan
authors: Deepa Aravindakshan
authors: DA
authors: Sarala
authors: Karimassery Ramaiyar
authors: KR
authors: Sundaram
authors: Raman Krishna
authors: RK
authors: Kumar
mesh_terms: D001827:Body Height; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000601:surgery*; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors