What determines nutritional recovery in malnourished children after correction of congenital heart defects?
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.
Vaidyanathan
Balu
B
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India. baluvaidyanathan@gmail.com
Radhakrishnan
Reshma
R
Sarala
Deepa Aravindakshan
DA
Sundaram
Karimassery Ramaiyar
KR
Kumar
Raman Krishna
RK
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