Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

Argent, Andrew C.; Balachandran, Rakhi; Vaidyanathan, Balu; Khan, Aijaz Ahmed; Kumar, Raman Krishna

doi:10.1017/s104795111700258x

Cited by 56 publications

(83 citation statements)

References 73 publications

(108 reference statements)

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“…Globally, congenital heart defect (CHD) represents one-third of all major congenital anomalies and are often associated with malnutrition and failure to thrive in children 1 . Growth failure in CHD has a multifactorial etiology, including genetic factors, chronic cyanosis, congestive heart failure, and pulmonary hypertension [2][3][4][5] , as well as an inability to feed properly 6 and, therefore, inadequate nutrient intakes 7 . In fact, cardiac-related malnutrition is a major challenge affecting an estimated 50%-90% of children with symptomatic CHD in developing countries 8 .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Zhang

Wang

Huang

et al. 2020

Preprint

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Background: The study aimed to investigate the risk factors of malnutrition in children with congenital heart defect (CHD) in China. Methods: This cohort study was performed at the biggest pediatric heart center in China; 3252 patients with CHD who underwent cardiac surgeries in 2013 were included. Anthropometric measurements included weight for age Z score (WAZ), weight for height Z score (WHZ), and height for age Z score (HAZ). The patients were classified as normal nutritional status and malnutrition, based on a cut-off Z score of <-2. Factors associated with malnutrition were determined using logistic regression analysis. Results: The prevalence of preoperative WAZ <-2 (underweight), HAZ <-2 (stunting), and WHZ<-2 (wasting) was 23.3%, 23.3%, and 14.3%, respectively. The multivariable analysis of preoperative malnutrition showed that hospitalization, age at surgery, risk adjustment for congenital heart surgery-1 >3, mechanical ventilation, pulmonary hypertension, and acyanotic heart disease were associated with underweight. Parents’ height, single ventricle, and cyanotic heart disease were associated with stunting. Hospitalization and pulmonary hypertension were associated with wasting. After surgery, the patients presented a significant improvement in growth within the first year in all three parameters and grew to the normal range of WAZ (-0.3±0.9, P<0.001), HAZ (0.2±0.8, P=0.001), and WHZ (0.03±0.6, P<0.001) at two years after surgery. The prevalence of underweight, stunted, and wasting declined to 3.2%, 2.7%, and 1.9% three years after surgery. Malnutrition after surgery was associated with cardiac residual cardiac abnormalities (OR=35.3, p<0.0001), high Ross classiﬁcation of heart function (OR=27.1, p<0.0001), and long-term taking oral diuretics (OR=20.5, P=0.001).Conclusions: Malnutrition is still a problem in children with CHD in China, especially before the surgery. There is need to strengthen the nutrition support for children with CHD before surgery. Hemodynamic factors were found to be the risk factors associated with malnutrition after operation.

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Section: Introductionmentioning

confidence: 99%

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Zhang

Wang

Huang

et al. 2020

Preprint

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Section: Introductionmentioning

confidence: 99%

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Zhang

Wang

Huang

et al. 2019

Preprint

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BackgroundThe study aimed to investigate the risk factors of malnutrition in children with congenital heart defect (CHD) in China. MethodsThis cohort study was performed at the biggest pediatric heart center in China; 3252 patients with CHD who underwent cardiac surgeries in 2014 were included. Anthropometric measurements included weight for age Z score (WAZ), weight for height Z score (WHZ), and height for age Z score (HAZ). The patients were classified as normal nutritional status and malnutrition, based on a cut-off Z score of <-2. Factors associated with malnutrition were determined using logistic regression analysis. ResultsThe prevalence of preoperative WAZ <-2 (underweight), HAZ <-2 (stunting), and WHZ<-2 (wasting) was 23.3%, 23.3%, and 14.3%, respectively. The multivariable analysis of preoperative malnutrition showed that hospitalization, age at surgery, risk adjustment for congenital heart surgery-1 >3, mechanical ventilation, pulmonary hypertension, and acyanotic heart disease were associated with underweight. Parents’ height, single ventricle, and cyanotic heart disease were associated with stunting. Hospitalization and pulmonary hypertension were associated with wasting. After surgery, the patients presented a significant improvement in growth within the first year in all three parameters and grew to the normal range of WAZ (-0.3±0.9, P<0.001), HAZ (0.2±0.8, P=0.001), and WHZ (0.03±0.6, P<0.001) at two years after surgery. The prevalence of underweight, stunted, and wasting declined to 3.2%, 2.7%, and 1.9% three years after surgery. Malnutrition after surgery was associated with cardiac residual cardiac abnormalities (OR=35.3, p<0.0001), high Ross classiﬁcation of heart function (OR=27.1, p<0.0001), and long-term taking oral diuretics (OR=20.5, P=0.001).ConclusionsMalnutrition is still a problem in children with CHD in China, especially before the surgery. There is need to strengthen the nutrition support for children with CHD before surgery. Hemodynamic factors were found to be the risk factors associated with malnutrition after operation.

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“…The overlap between malnutrition and CHD is of critical importance in LMIC where malnutrition is often multifactorial (Argent, Balachandran, Vaidyanathan, Khan, & Kumar, ). A Ugandan study found that malnutrition was common in children with CHD, and is associated with both anemia and moderate to severe heart failure (Batte et al, ).…”

Section: Morbiditymentioning

confidence: 99%

“…By using a disease modeling software (DisMod-MR 2.1) from the GBD study, estimates can be made for regions with limited data. In 2017, there were an estimated 7,280,754 DALYs (95% CI 4,922,727-9,567,795) due to CHD in low socio-demographic index The overlap between malnutrition and CHD is of critical importance in LMIC where malnutrition is often multifactorial (Argent, Balachandran, Vaidyanathan, Khan, & Kumar, 2017). A Ugandan study found that malnutrition was common in children with CHD, and is associated with both anemia and moderate to severe heart failure (Batte et al, 2017).…”

Section: Morbiditymentioning

confidence: 99%

Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

Zimmerman

Sable

2020

American J of Med Genetics Pt C

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The etiology of congenital heart disease (CHD) is multifactorial. The birth prevalence of CHD is shaped by a wide variety of maternal, fetal, and neonatal risk factors, along with the rates of prenatal diagnosis and terminations of pregnancy, all of which have geographic variability Epidemiology data availability from low‐and‐middle‐income countries (LMIC) on CHD prevalence, morbidity, and mortality are far more limited than from high income countries. Data on specific genetic, environmental, and prenatal risk associated with CHD are almost nonexistent. In this article, we will focus on defining what data are available, genetic risk factors, birth and overall prevalence, morbidity, and the impact of limited access to interventions, both surgery and cardiac catheterizations. We will highlight CHD in sub‐Saharan Africa to detail epidemiology studies in the poorest regions of the world. Existing literature as well as estimates from the Global Burden of Disease Study (http://ghdx.healthdata.org) form the basis for this review. The intersection of poverty, high fertility rates, and limited access to care results in a unique profile of CHD in LMIC. CHD is not a preventable disease (by most standards), so early detection and access are our key interventions to improve the dire outcomes for children in low‐resources settings of the world.

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Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries

Cited by 56 publications

References 73 publications

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Risk Factors of Malnutrition in Chinese Children with Congenital Heart Defect

Congenital heart disease in low‐and‐middle‐income countries: Focus on sub‐Saharan Africa

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