Prevalence, profile of malnutrition and iron deficiency anemia in children with cyanotic congenital heart defects: a case control observational study in a tertiary care hospital in North India

Abstract

Background: Children with congenital heart disease (CHD) are prone to malnutrition. Children with cyanotic CHD [CCHD] are specifically affected due to chronic hypoxia and iron deficiency anemia which is overlooked by pediatrician. This can have a significant effect on the outcome of surgery. Our objective was to determine the burden and determinant of malnutrition in children with several types of cyanotic congenital heart disease (CCHD).Methods: This case-control study included 80 children with symptomatic CCHD, and 40 healthy children matched for age and sex as a control group. Clinical evaluation and laboratory assessment of nutritional status were documented. Anthropometric measurements were recorded and Z scores for weight for age (WAZ), weight for height (WHZ), and height for age (HAZ) have been calculated. Haemoglobin, red cell indices and serum iron, total iron binding capacity and serum ferritin was done in cases and controls.Results: The overall prevalence of malnutrition was 72.5% in patients with CCHD and 22.5% in controls. Severe malnutrition was diagnosed in 68.9% of cases. All anthropometric measurements which markers of nutritional state are were significantly lower in the patients group compared to controls. The prevalence of iron deficiency anemia (IDA) was 47.5% in the study population. The study also showed that hemoglobin and hematocrit levels, RBC count were paradoxically higher in the cyanotic CHD as compared to the healthy controls though the iron studies revealed the iron deficiency. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) mean corpuscular hemoglobin concentration (MCHC), serum ferritin, serum iron, total iron binding capacity (TIBC), values were the parameters, which were found to be statistically significant to differentiate the study groups.Conclusions: Malnutrition is a very common problem in children with symptomatic CCHD, the prevalence of IDA in children with CCHD was found to be high.

Anemia in Children with Congenital Heart Disease: A Finding from Low-Resource Setting Hospitals

“…However, iron deficiency anemia is reported to be common in individuals with CCHD even in the presence of high hematocrit levels. This explanation strengthen by the study conducted in India showed that hemoglobin and hematocrit levels and RBC count were paradoxically higher in the CCHD as compared to the healthy controls [21]. Regarding the ACHD cases, the prevalence of anemia in our study was equivalent to that found in studies conducted by Mohammadi et al and Gaiha et al [16,20].…”

The Differences in Mentzer Index between Cyanotic and Acyanotic Congenital Heart Diseases

“…The overall prevalence was 90.4% in case group compared to 21.1% control group (Okoromah et al, 2011). The study done by Mir et al, (2019) also reported 72.5% prevalence of poor nutritional status in 29 from 40 children with CHDs compared to 22.5% prevalence of children without CHDs but had poor nutritional status (Mir et al, 2019). Similarly, in Padang and Egypt, in the study by Hermawan et al, (2015) and Hassan et al, (2015) reported higher cases of poor nutritional status in all patients with CHDs, regardless of the type of CHDs they were suffering from (Hassan et al, 2015;Hermawan et al, 2015).…”

Prevalence of iron deficiency anaemia in congenital heart disease in children

“…In their investigation, Mir AB et al, 20 found that the prevalence of malnutrition overall was 72.5% in CHD patients and 22.5% in controls. In 68.9% of instances, severe malnutrition was found to be present.…”

“…A related study by Ossei I et al, 19 found that 47% of CHD cases had absolute iron deficit and 72.7% of cases had relative iron shortage. In their investigation, Mir AB et al, 20 found that 47.5% of the CHD population had iron deficiency anaemia (IDA). In contrast to the general population, patients with cyanotic cardiac disease had their iron deficient anaemia evaluated by Sumeet Soni et al 22 In cases of cyanotic heart disease, the mean haemoglobin was 13.39 gm/dl with a 2.38 SD.…”

“…Iron deficiency as defined by s. ferritin< 12 ng/ml was seen in 51% cases of acyanotic CHD as compared to 77.8% in cyanotic CHD (p-0.16). 100 patients with various forms of cyanotic and acyanotic congestive heart failure had their pre-operative charts examined by H Amoozgar et al 12 The mean Hb and MCV of the cyanotic patients were 15.97 ± 17.19 and 73.76 ± 27.26, respectively, while the mean Hb of the acyanotic group was 13.56 ± 9.44 and the MCV was 80.4 ± 12.36... Mir AB et al, 20 observed that haemoglobin and haematocrit levels, RBC count were paradoxically higher in the cyanotic CHD as compared to the controls. However in both the studies, through the iron studies, it was revealed that iron stores were depleted in this group, similar to present study.…”