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Early weight trends after congenital heart surgery and their determinants

Published online by Cambridge University Press:  26 December 2019

Nayan Banerji ,
Abish Sudhakar ,
Rakhi Balachandran ,
Gopalraj Sumangala Sunil ,
Brijesh P. Kotayil  and
Raman Krishna Kumar Open the ORCID record for Raman Krishna Kumar [Opens in a new window]
Nayan Banerji
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
Abish Sudhakar
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
Rakhi Balachandran
Affiliation:
Department of Cardiac Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
Gopalraj Sumangala Sunil
Affiliation:
Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
Brijesh P. Kotayil
Affiliation:
Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
Raman Krishna Kumar*
Affiliation:
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
*
Author for correspondence: R. Krishna Kumar, MD, DM, FAHA, Clinical Professor and Head, Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin 682041, Kerala, India. Tel: +91-4842853570; Fax: +91-484-2852020. E-mail: [email protected]
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Abstract

Background:

Early weight trends after cardiac surgery in infants from low- and middle-income countries where the majority are undernourished have not been defined. We studied the early post-operative weight trends to identify specific factors associated with early weight loss and poor weight gain after discharge following congenital heart surgery in consecutive infants undergoing cardiac surgery at a referral hospital in Southern India.

Methods:

This was a prospective observational study. Weights of the babies were recorded at different time points during the hospital stay and at 1-month post-discharge. A comprehensive database of pre-operative, operative, and post-operative variables was created and entered into a multivariate logistic regression analysis model to identify factors associated with excessive early weight loss after cardiac surgery, and poor weight gain following hospital discharge.

Results:

The study enrolled 192 infants (mean age 110.7 ± 99.9 days; weight z scores − 2.5 ± 1.5). There was a small but significant (p < 0.001) decline in weight in the hospital following surgery (1.6% decline (interquartile range −5.3 to +1.7)); however, there was substantial growth following discharge (26.7% increase (interquartile range 15.3–41.8)). The variables associated with post-operative weight loss were cumulative nil-per-oral duration and cardiopulmonary bypass time, while weight gain following discharge was only associated with age.

Conclusion:

Weight loss is almost universal early after congenital heart surgery and is associated with complex surgery and cumulative nil-per-oral duration. After discharge, weight gain is almost universal and not associated with any of the perioperative variables.

Keywords

CHDcardiac surgerymalnutrition
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 89 - 94
Copyright
© Cambridge University Press 2019

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References

Tchervenkov, CI, Jacobs, JP, Bernier, PL, et al.The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young 2008; 18 (Suppl 2): 63–69.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Castaneda, AR, Cherian, KM, et al.Reducing mortality and infections after congenital heart surgery in the developing world. Pediatrics 2014; 134: e1422–e1430.CrossRefGoogle ScholarPubMed
Vaidyanathan, B, Roth, SJ, Rao, SG, Gauvreau, K, Shivaprakasha, K, Kumar, RK.Outcome of ventricular septal defect repair in a developing country. J Pediatr 2002; 140: 736–741.CrossRefGoogle Scholar
Reddy, NS, Kappanayil, M, Balachandran, R, et al.Preoperative determinants of outcomes of infant heart surgery in a limited-resource setting. Semin Thorac Cardiovasc Surg 2015; 27: 331–338.CrossRefGoogle Scholar
Weintraub, RG, Menahem, S.Early surgical closure of a large ventricular septal defect: influence on long term growth. J Am Coll Cardiol 1991; 18: 552–558.CrossRefGoogle ScholarPubMed
Levy, RJ, Rosenthal, A, Miettinen, OS, Nadas, AS.Determinants of growth in patients with ventricular septal defect. Circulation 1978; 57: 793–797.CrossRefGoogle ScholarPubMed
Cheung, MMH, Davis, AM, Wilkinson, JL, Weintraub, RG.Long term somatic growth after repair of tetralogy of fallot: evidence for restoration of genetic growth potential. Heart 2003; 89: 1340–1343.CrossRefGoogle ScholarPubMed
Swan, JW, Weintraub, RG, Radley-Smith, R, Yacoub, M.Long term growth following neonatal anatomic repair of transposition of the great arteries. Clin Cardiol 1993; 16: 392–396.CrossRefGoogle ScholarPubMed
Schuurmans, FM, Pulles-Heintzberger, CF, Gerver, WJ.Long term growth of children with congenital heart disease: a retrospective study. Acta Pediatr 1998; 87: 1250–1255.CrossRefGoogle ScholarPubMed
Rhee, EK, Evangelista, JK, Nigrin, DJ, Erickson, LC.Impact of anatomic closure on somatic growth among small asymptomatic children with secundum atrial septal defect. Am J Cardiol 2000; 85: 1472–1475.CrossRefGoogle ScholarPubMed
Kumar, RK, Shrivastava, S. Pediatric heart care in India. Heart 2008; 94: 984–990.CrossRefGoogle ScholarPubMed
Argent, AC, Balachandran, R, Vaidyanathan, B, Khan, AKumar, RK.Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries. Cardiol Young 2017; 27: S22–S30.CrossRefGoogle ScholarPubMed
Mishra, D, Singh, H.Kuppuswamy socioeconomic status scale - a Revision. Indian J Pediatr 2003; 70: 273–274.CrossRefGoogle Scholar
Wright, CM, Cheetham, TD.The strengths and limitations of parental heights as a predictor of attained height. Arch Dis Childhood 1999; 81: 257–260.CrossRefGoogle ScholarPubMed
Cavalcante, CT, de Souza, NMG, Pinto, VC Jr, et al.Analysis of surgical mortality for congenital heart defects using RACHS-1 risk score in a Brazilian single center. Braz J Cardiovasc Surg 2016; 31: 219–225.Google Scholar
Vaidyanathan, B, Nair, SB, Sundaram, KR, et al.Malnutrition in children with congenital heart disease (CHD) determinants and short term impact of corrective intervention. Indian Pediatr 2008; 45: 541–546.Google ScholarPubMed
Finnerty, CC, Mabvuure, NT, Ali, A, Kozar, RA, Herndon, DN.The surgically induced stress response. J Parenter Enteral Nutr 2013; 37: 21s–29s.CrossRefGoogle ScholarPubMed
Vaidyanathan, B, Roth, SJ, Gauvreau, K, Shivaprakasha, K, Rao, SG, Kumar, RK.Somatic growth after ventricular septal defect in malnourished infants. J Pediatr 2006; 149: 205–209.CrossRefGoogle ScholarPubMed