Nutritional assessment and surgical risk makers in children submitted to cardiac surgery

Abstract

In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%). The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0.0019; arm muscle circumference, p = 0.0419). The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0.01) compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

Is undernutrition prognostic of infection complications in children undergoing surgery? A systematic review

“…12,21 The remaining 10 studies were performed in children with a minimum age of three days and overall median age of 10.6 months. 23 Four studies were undertaken in cardiac surgical populations, 13,20,21,29 and four studies were undertaken in general surgical populations, mainly gastrointestinal/abdominal surgery. 16,17,26,27 Two studies were performed in spinal surgical populations, 25,29 and one study comprised of cardiac, neurosurgical and general surgical participants.…”

“…23,24 Where participant numbers were low for the given study period, studies were downgraded to unclear risk of bias. 13,25,26 Unclear or non-validated infection definitions, 25 or unclear or less than accepted durations of follow-up made it difficult to assess exposure and/or case selection; these studies were downgraded accordingly. 13,16,17,20,21,24,26 Any study that adjusted for age and/or case complexity met the criteria for comparability.…”

“…13,25,26 Unclear or non-validated infection definitions, 25 or unclear or less than accepted durations of follow-up made it difficult to assess exposure and/or case selection; these studies were downgraded accordingly. 13,16,17,20,21,24,26 Any study that adjusted for age and/or case complexity met the criteria for comparability. 20,21,23,24 Studies that did not provide details about adjustment, studies that reported 'no difference between groups', and studies that undertook…”

“…13,16,17,24,27 The results of quality assessment are presented in Table I. Overall, two studies were rated as moderate quality and eight studies were rated as low quality.…”

“…Moreover, only two of the included studies reported infection-related outcomes. 12,13 These observations indicate that the relationship between undernutrition and postoperative infection complications in children has not been fully delineated, justifying the need for a systematic review of the existing research literature. The subject area is important because nutritional status is a potentially modifiable risk factor.…”