Nutritional Status and Clinical Outcome in Postterm Neonates Undergoing Surgery for Congenital Heart Disease*

Mitting, Rebecca; Marino, Luise V.; MacRae, Duncan; Shastri, Nitin; Pathan, Nazima

doi:10.1097/pcc.0000000000000402

Cited by 90 publications

(77 citation statements)

References 23 publications

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“…Lower WLZ, called "wasting", represents acute malnutrition and lower LAZ, called "stunting", represents chronic malnutrition (25), lower WAZ also indicates immediate malnutrition. The prevalence of underweight, stunting and wasting in the study of Hassan et al (26) in 2015 in Egypt reported to be 14.3%, 61.9% and 23.8%; but the prevalence of the aforementioned variables in the study of Okoromah et al (9) in 2011 in Nigeria were 20.5%, 28.8% and 41.1%, and the relative proportions of the underweight, stunting and wasting in the study of the Ratanachu-Ek (27) in 2011 in Thailand were 28%, 16% and 22%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

et al. 2020

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Background:Patients with congenital heart disease (CHD) are susceptible to mild malnutrition up to failure to thrive. The prevalence of malnutrition among patients with CHD is higher in developing countries. Many factors are considered to affect the nutritional status such as cyanosis.Objectives: This study aims to assess the prevalence and severity of malnutrition in patients with CHD prior to the surgical corrective or palliative repair. Methods: This study was performed by reviewing inpatient medical records and cardiac surgery databases of children with cyanotic CHD who underwent palliative or corrective surgery between March 2011 and March 2017. Patients' age and height at the time of surgery, birth weight, duration of intensive care unit (ICU) stay and 30-day mortality were extracted and weight for age z score (WAZ), weight for length z score (WLZ) and length for age z score (LAZ) were calculated. Z scores above -1 were considered as normal, between -1 and -2 as mild, between -2 and -3 as moderate and below -3 as severe malnutrition. Results:In a total number of 639, the average age, weight and height were 16.688 ± 24.859 months, 7.509 ± 5.629 kilograms and 73.759 ± 95.869 centimeters, respectively. The average length of ICU stay was 8.36 ± 6.254 days and the 30-day mortality was 36 (5.7%). The average WAZ, LAZ, WLZ and BMI Z was -1.5 ± 1.69, -0.9 ± 2.38, -1.2 ± 3.97 and -1.4 ± 2.11, respectively. Regarding WAZ, LAZ, WLZ and BMI Z, 62.2%, 46.1%, 72.3% and 70.9% of patients had mild to severe forms of malnutrition, since the rate of malnutrition based on WAZ (P = 0.001), LAZ (P < 0.0001), WLZ (P < 0.0001) and BMI Z (P = 0.007), was significantly higher than normal subjects. Conclusions: The prevalence of mild to severe forms of malnutrition, based on different growth indices, for both cyanotics and acyanotics are higher than those reported in the other previous studies. These findings reflect the fact that cultural, genetic and racial differences of Iranians compared to others, cause malnutrition to be more frequent in Iranian CHD children. This calls for higher requirement of nutritional support for these patients.

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Section: Discussionmentioning

confidence: 99%

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

et al. 2020

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“…Malnutrition is associated with prolonged PICU-LOS, increased morbidity and mortality (29,31,(52)(53)(54) , with a reported incidence of up to 24% in European centres (55)(56)(57) . In the present study, the incidence of moderate acute and persistent malnutrition was similar in both units with 16%-18%.…”

Section: Discussionmentioning

confidence: 99%

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

Marino

Eveleens

Morton

et al. 2019

J Human Nutrition Diet

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Background Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient‐energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). Methods Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU‐1 and 4.7 kg in PICU‐2. Median (interquatile range) energy intake in PICU‐1 and PICU‐2 was 68 (47–92) and 90 (63–124) kcal kg−1, respectively, and median (interquatile range) protein intake 1.7 (1.1–2.4) g kg−1 and 2.5 (1.6–3.2) g kg−1, respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU‐1 for 2.5 h and in two infants (7%) on two occasions in PICU‐2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg−1 in PICU‐1 and 16.9 (15.6) mL kg−1 in PICU‐2. Conclusions Peptide nutrient‐energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.

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“…These patient populations are known to be most vulnerable to postoperative morbidity, and are most vulnerable to further nutritional depletion during their inpatient stay. 6,9,10 There is a need for large, adequately powered prospective studies incorporating a gold-standard method for nutritional assessment, with robust and consistently applied definitions of undernutrition and infectious complications. If undernutrition is a risk factor for infection, aspects of pre-and postoperative feeding practices could be modified in order to reduce the physical, psychosocial and financial burdens associated with HCAIs in children.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Poor nutritional status (measured by lower weight-for-age zscores) has been associated with increased duration of mechanical ventilatory support, increased length of stay and increased one-year mortality in neonates undergoing surgery within an intensive care setting. 10 A recent evidence-based review of the literature found weak evidence of preoperative nutritional assessment being predictive of adverse clinical outcomes in paediatric surgical patients. 11 However, this review only identified six studies in total, five of which were undertaken in a paediatric cardiac surgical population, limiting the validity of these findings to other surgical populations.…”

Section: Introductionmentioning

confidence: 99%

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

Hill

Paulus

Dey

et al. 2016

Journal of Hospital Infection

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Background: Healthcare-associated infections are costly and are increasingly viewed as an indicator of the quality of care. Although strategies to reduce infections have become widespread, few studies have formally investigated the role of undernutrition on the development of infection-related complications in children after surgery. Aim: To perform a systematic review of the literature to determine if undernutrition is prognostic of postoperative infection complications in children. Methods: Electronic bibliographic and research databases were searched from 1950 to 2014. Inclusion criteria were studies in children (age <18 years) evaluating pre-operative nutritional status and reporting postoperative infection complications. Quality assessment was performed independently by two reviewers, with disagreements resolved by a third reviewer. The quality of the evidence was judged to be low in the majority of studies. Findings: Ten cohort and two caseecontrol studies met the inclusion criteria. Five studies reported an outcome combining infection-related complications, with the remainder reporting individual infection complications. Six studies reported surgical site infection (SSI) alone or in combination with other infection complications. Direct comparison between studies was difficult due to clinical and diagnostic heterogeneity. Unadjusted analyses (for patient or clinical variables) were suggestive of a relationship between undernutrition and infection complications. In studies controlling for other variables, the analyses did not remain significant for SSI. Conclusion: There was low-quality evidence that undernutrition may be predictive of postoperative infection complications in children, with the exception of SSI. However, inconsistencies in nutritional and outcome assessments made it difficult to draw conclusions. Larger, high-quality studies are warranted to further investigate a potential prognostic relationship. ª

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Nutritional Status and Clinical Outcome in Postterm Neonates Undergoing Surgery for Congenital Heart Disease*

Abstract: Poor nutritional status as measured by weight-for-age z is associated with adverse short- and long-term outcomes in neonates undergoing surgery for congenital heart disease.

Cited by 90 publications

References 23 publications

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

Peptide nutrient‐energy dense enteral feeding in critically ill infants: an observational study

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

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