title: 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).
abstract: OBJECTIVE
  The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD).
  
  
  METHODS
  Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought.
  
  
  RESULTS
  Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels.
  
  
  CONCLUSIONS
  Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
authors.affiliation: Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif.
authors.forename: Monique
authors.initials: M
authors.lastname: Radman
authors.affiliation: Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mack
authors.affiliation: Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala; Surgery, Washington University, St. Louis, Mo; Division of Public Health Sciences, Washington University, St. Louis, Mo.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Barnoya
authors.affiliation: Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala.
authors.forename: Aldo
authors.initials: A
authors.lastname: Castañeda
authors.affiliation: Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala.
authors.forename: Monica
authors.initials: M
authors.lastname: Rosales
authors.affiliation: Surgery, University of California, San Francisco, Calif.
authors.forename: Anthony
authors.initials: A
authors.lastname: Azakie
authors.affiliation: Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Pediatrics, University of California, San Francisco, Calif.
authors.forename: Roberta
authors.initials: R
authors.lastname: Keller
authors.affiliation: Pediatrics, University of California, San Francisco, Calif.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Datar
authors.affiliation: Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif.
authors.forename: Peter
authors.initials: P
authors.lastname: Oishi
authors.affiliation: Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif. Electronic address: jeff.fineman@ucsf.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fineman
mesh_terms: D050154:Adiposity; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015362:Child Nutrition Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005260:Female; D006166:Guatemala; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009752:Nutritional Status; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012495:San Francisco; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012885:Skinfold Thickness; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D002316:Cardiotonic Agents; D011228:Prealbumin; D012709:Serum Albumin; D020097:Natriuretic Peptide, Brain; D000075462:Serum Albumin, Human
keywords: 18; 20; 21; B-type natriuretic peptide; BMI; BNP; CHD; CI; CPB; ICU; LOS; La Unidad de Cirugia Cardiovascular de Guatemala; PCICU; TSFZ; UCSF; UNICAR; University of California at San Francisco; WHO; World Health Organization; body mass index; cardiopulmonary bypass; confidence interval; congenital heart disease; intensive care unit; length of stay; pediatric cardiac intensive care unit; triceps skin-fold-for-age z score