Background: To identify the prevalence, predictors and implications of malnutrition and failure to thrive (FTT) in paediatric cardiac surgical patients.Methods: Observational retrospective analysis of data of paediatric patients presenting for cardiac surgery at Queen Alia heart institute/Amman/Jordan between April 2020 and October 2020. Patients' ages, anthropometric measurements, diagnoses, type of surgical intervention, ICU stay and perioperative outcomes were recorded on a special form designed for the purpose of this study. Prevalence of malnutrition based on world health organization (WHO) and centers for disease control (CDC) growth charts was determined using height-for-age z-score (HAZ) and percentile, weight-for-age z-score (WAZ) and percentile, weight-for-height z-score (WHZ) and percentile. BMI was used for patients above 2 years of age in 109 paediatric cardiac surgical patients. Prevalence of malnutrition and FTT was examined according to age category and cardiac pathology). Patients were divided according to heart pathology into cyanotic and acyanotic CHD.Results: One hundred and nine pediatric cardiac surgical patients were presented for cardiac surgery (59 males and 50 females). Patients' age ranged from 2 days to 17 years (mean 3.7 years, SD±4.5 years). Patients' body weight ranged from 2.7 to 70 kg (mean 14.98 kg, SD±14.2 kg). Average weight percentile was 19.26 (SD±20.01) and ranged between 0.1 and 88.5 and the average Z-score for weight was -1.274±1.037 (mean±SD). The overall height percentile for the all patients with CHD averaged 18.53±17.1 (mean±SD) and the average Z-score for height was -1.1029±0.743 (mean±SD). Prevalence of isolated malnutrition and FTT was 33.2% and 20.2%. Normal nutritional status was found in 46.78%. Cyanotic type CHD was more commonly associated with FTT (p=0.001), longer cardiopulmonary bypass (p=0.001), higher intraoperative lactate (p=0.012) and aortic cross clamp times (p=0.001). Patients with malnutrition and FTT had average ICU stay of 4.32±2.219 days and averaged 4.772±2.065 days (mean±SD) respectively, which was almost double of the ICU stay of patients who had normal nutritional status 2.32±2.261 days (mean±SD).Conclusions: Prevalence of malnutrition and FTT is high in paediatric patients with CHD at time of presentation for surgery. Predicting factors for malnutrition and FTT are cyanotic type of CHD and smaller age. Malnutrition was associated with longer ICU stay.

Background: To review the indications, patients' demographics, and anaesthetic protocol and to analyze perioperative complications of liver transplantation surgery.Methods: Retrospective analysis of 70 cases of LT in the period between June 2004 and October 2020 at King Hussein medical centre. Preoperative factors such as patients' demographics, age, gender, etiology of hepatic pathology, laboratory investigations, model for end-stage liver disease scores, duration of surgery and type of liver donation were recorded. Intraoperative factors such as anaesthetic and surgical protocols, need of blood product transfusions and haemodynamic monitoring were analyzed. Postoperative tracking of patients' complications and outcomes was done.Results: 68 living donor and two cadaveric LT procedures. Male to female ratio was 2.9:1.The age of LT recipients ranged from 3 to 62 years with an average age of 38.45 years. Their body weights ranged from 13 to 100 kg with mean body weight of 67.03 kg. Most common indication was cryptogenic liver cirrhosis (21.4%), followed by cirrhosis due to viral hepatitis B (15.7%). Autoimmune hepatitis was an indication in 11.4% and hepatitis C liver cirrhosis in 10%. All living donors were closely related. Right hepatic lobe graft was used in 85.7% of transplantations. Average red cells concentrate (RCC) transfused (units) was 3.1±3.97 (mean±SD). Duration of surgery (hours) was 12.5±2.4 (mean±SD). Fast track LT with extubation in theatre was done in 37 LT recipients (52.9%). Readmission to operative theatre was needed in 5 recipients (7.14%). Most common long term complications were biliary leak (20%), biliary stenosis (14.2%) and recurrence of primary disease (12.9%).Conclusions: Transplantation from living donors was by far more common in our study population. Majority of recipients were male and cryptogenic liver cirrhosis was the most common indication. Right hepatic lobe graft was used mostly. Biliary leak was the most common postoperative complication. Surgical time duration and blood products transfusion decreased significantly over years since the start of LT program.